Taking opioids to relieve pain can make primary care more difficult, study finds

Finding a new doctor for health exams and general care can be a challenge for anyone. But for people taking prescription opioid medications to relieve their chronic pain, this could be much more difficult, according to a new study.

In fact, 40% of the 194 primary health care clinics contacted as part of the study stated that they would not accept a new patient taking Percocet daily to relieve the pain of pain. an earlier injury, regardless of the type of health insurance he enjoyed.

17% of clinics said they wanted to get more information before deciding to take the patient; Two-thirds of them said they would like the patient to come for a preliminary appointment before making a decision. All the study clinics accepted new patients at that time.

The results, published in JAMA Network open now A team from the University of Michigan suggests that more patients taking opioids for the treatment of chronic pain might have problems accessing healthcare compared to previous studies.

However, the team found that large clinics and those offering coverage by a safety net were three times more likely than others to accept patients currently taking opioids for the treatment of pain. chronic.

More than pain care

For these patients, access to primary care goes beyond exams, preventive care and management of health problems, says lead researcher Pooja Lagisetty, M.D., M.Sc.

Having a regular provider could allow them to receive other treatments for pain relief and, if necessary, guide them in gradually and safely reducing their use of opioids.

Primary health care providers may also provide patients who are taking opioids or their loved ones with "rescue" medication for use in opioid overdose, detect signs of opioid-related disorders, and treat these if the patient is one of the minority cases of people on long-term opioid prescription treatment developing drug dependence.

The researchers note that without access to such care, patients can turn to other ways to procure opioids, outside of a prescription from a regular provider. This can also lead to a deterioration in the health status of their other medical problems such as diabetes or hypertension.

In fact, says Lagisetty, this is what led her and her colleagues to launch the study with funding from the Michigan Health Endowment Fund. Lagisetty is a general practitioner in internal medicine at Michigan Medicine, the University Medical Center of U-M, and at the VA Ann Arbor Health System.

"Anecdotally, we heard that patients with chronic pain became" pain refugees ", that they suddenly stopped taking opioids, or that their current doctor stopped renewing their prescriptions, which left them with seek relief from pain elsewhere, "she says. "However, no studies have been done to quantify the magnitude of the problem." These results are worrying as they show how difficult it can be for a patient with chronic pain to seek out a primary care physician. . "

Call for care

The team conducted the study using a so-called "secret client" method, to give a realistic idea of ​​what clinics would say to a caller about whether their parent can get an appointment. you as a new patient. The first set of calls was sent to 667 randomly selected Michigan clinics, asking them if they were accepting new patients in primary care and for other issues.

For the second series of calls, the researchers used the scenario of a calling adult child on behalf of a parent, so that it was not necessary that the conversations include detailed information about the patient to make an appointment.

The appellants also stated that their "parent" was taking medications for high blood pressure and high cholesterol, two conditions that primary health care providers play a key role in managing.

The researchers wanted to know if the type of insurance, the size or type of clinic or the population density around the clinic played any role. Half of the callers said that their relative had Medicaid, the other half a Blue Cross Blue Shield blanket. Nearly half of the clinics were in rural areas and almost one-third had only one provider. Nine per cent were community health centers, providing care for all, regardless of their ability to pay.

"Our results did not differ by insurance status, which was surprising because previous studies on access to primary care had shown that Medicaid patients tended to have more access to primary care. weaker than those with private insurance, "said Lagisetty. "This may indicate that providers and clinics are not making the decision to restrict access based on reimbursement." Larger clinics and community health centers were more likely to accept new patients, suggesting that they could be system level factors that affect access to care. "

There was no difference in access between rural and urban areas.

Get help for addiction issues

The researchers also examined the availability of treatments for opioid consumption disorders in primary care clinics.

Such treatment, which requires providers to receive special training and authorization from the federal government, involves counseling and prescriptions for drugs that can block the symptoms of opioid withdrawal. Lagisetty examined the feasibility of primary care clinics offering this type of treatment and the differences in access to it.

Front-line staff from 12% of the clinics participating in the study said their providers offered this type of drug-based OUD care. Nearly 41% told callers that they did not know if their suppliers could offer it.

Next steps

What factors play into the decision of a clinic to take new patients with chronic pain who are taking prescription opioids? Lagisetty notes that patient advocates have put blame on a chronic pain treatment guide published in 2016 by the Centers for Disease Control and Prevention, which they view as tilting the pendulum of pain treatment too far prescribed opioids.

"I guess that's only a small part of the problem," said Lagisetty, a member of the U-M Institute for Health Policy and Innovation. "States, including Michigan, have implemented many other policies that are only rarely based on guidelines, with the goal of limiting the prescription of opioids."

The Michigan team wants to explore in more detail the factors behind this phenomenon and to determine the importance of recent guidelines and policies, the stigmatization of patients on opioid therapy, and the fear of the legal implications of providers.

"We hope to use this information to identify a way to correct the policies to put in place a more patient-centered approach to pain management," said Lagisetty. "Everyone deserves equitable access to health care, regardless of one's health status or the medications that it takes."