Summary: A new study found that many primary care physicians are reluctant to take patients if they find that the patient has been using medical opioids or cannabis for their chronic pain. These findings are in line with previous findings that lack of adequate access to medical care is forcing many chronic pain patients to buy opioids or medical cannabis from the black market.
Studies have continually shown that doctors are hesitant to take patients who use opioids or cannabis for chronic pain management. Of course, here we are talking about medical opioids or cannabis. This has been an ongoing trend for the last few years, as evidenced by previous studies and the latest study done by the University of Michigan.
Chronic pain patients using these medications find it hard to find a primary care physician. In the new study, lead author Mark Bicket, MD, surveyed 1000 US physicians from various US states, and the findings were alarming in every way.
The study finally included a survey of 852 physicians. It found that about one-third of primary care physicians would not accept patients who use opioids daily for their chronic pain. Not only that, one-fifth would not accept patients who used prescription opioids for their pain now and then.
Here, it is also worth noting that the study was only done in states with medical cannabis programs, which means that one can expect doctors to be more willing to accept such patients in these states due to higher awareness. However, things might be even worse in other states.
Things were slightly better with medical cannabis, with 18% of doctors saying that they would not take patients with a history of medical cannabis use. Even worse, 40% said that they would not accept patients if the source of cannabis were unclear or if patients bought it from the black market.
There are a few reasons for raising this concern. Health experts note that there are many legacy patients. They have been taking opioids for chronic pain for years. In such patients, other medications are less likely to provide pain relief. Moreover, many of them are satisfied with their treatment or pain control, so changing treatment is not necessary. However, finding a new doctor for these patients may be challenging.
Further, it is also important to note that though opioid prescription rates are declining, that is not true for medical cannabis. In fact, medical cannabis use is becoming more popular these days.
Perhaps the biggest problem that may arise from this hesitation by doctors to accept this group of patients is that many of them will be forced to buy these substances from the black market. However, this will put them at unnecessary risk. Not only that, this also increases the risk of substance use disorder. It is vital that these patients have access to high-quality medical opioids or cannabis.
This is not the first study to show the hesitance among the doctors. Previous studies also had similar findings.
Not only that, in yet another study, researchers from the University of Michigan found that barely 40% of primary care physicians are willing to treat patients who use opioids. In one of the surveys, they called the doctors for an appointment and said that the patient was taking an opioid Percocet. To the amazement of the researchers, refusal rates to provide an appointment were above 50%.
All this means a lack of sufficient care for many chronic pain patients. It appears that this hesitation is pushing many chronic pain patients to the wrong path. Many of them would buy these drugs from the black market, which can not just increase the risk of substance use disorder but also harm health as many of these drugs sold in the black market have high levels of contaminants. Spreading awareness on using interventional pain management by consulting a chronic pain specialist can reduce the risk of cannabis and opioid abuse.
Frequently asked questions
Do doctors refuse new patients who take opioids for chronic pain?
Many do. In a University of Michigan survey of 852 primary care physicians, about one-third said they would not accept a new patient who takes opioids every day for chronic pain. One-fifth would turn away someone who uses prescription opioids only now and then. The survey covered only states with medical cannabis programs, where doctors may be more open, so access in other states could be worse.
Will a primary care doctor accept a patient who uses medical cannabis?
Most will, but not all. In the same survey, 18% of primary care doctors said they would not take a patient with a history of medical cannabis use. That number jumped to 40% when the source of the cannabis was unclear or it came from the black market. Opioid prescribing is falling while medical cannabis use keeps growing, so more patients are running into this wall.
How often do doctors’ offices turn away patients who take opioids?
More often than not. In a separate University of Michigan study, researchers called primary care offices for an appointment and said the patient was taking the opioid Percocet. More than half of the offices refused. Only about 40% of primary care physicians were willing to treat patients who use opioids. Earlier studies found the same pattern, so this is a trend that has run for years, not a one-time result.
What happens to chronic pain patients who cannot find a doctor?
Many end up buying opioids or cannabis on the black market. That puts them at unnecessary risk: drugs sold there often carry high levels of contaminants, and buying outside medical care raises the risk of substance use disorder. Legacy patients, who have taken opioids for years, are hit hardest. Other medications are less likely to relieve their pain, and many are already satisfied with their pain control.
What should I do if my doctor refuses to give me pain medication?
Do not turn to the street. Instead, see a chronic pain specialist. Interventional pain management, delivered by a specialist who treats chronic pain every day, lowers the risk of cannabis and opioid misuse. If you are a long-term opioid patient whose pain is well controlled, changing your treatment is not always necessary, so bring your full history to the visit.
Source:
Bicket, M. C., Stone, E. M., Tormohlen, K., Pierre, R., & McGinty, E. E. (2024). Access to care for patients with chronic pain receiving prescription opioids, cannabis, or other treatments. Health Affairs Scholar, 2(6), qxae086. https://doi.org/10.1093/haschl/qxae086
Dr. Gurpreet Singh Padda, MD, MBA, MHP
