Summary: A new survey of 452 primary care clinics confirms that almost half of all clinics in the US do not want to take patients who use opioids to manage their pain. They worry they might get in legal trouble. They also think the patients must be abusing opioids. But even abuse is no reason to refuse care, because turning people away may push them to street drugs. Many people live with chronic pain and need opioids to control it. If they ever need a new physician, the search gets very hard. It is hard to find a physician ready to prescribe opioids for their chronic pain.
Most Americans already know it is hard to find a doctor who will treat their chronic pain. It is harder still if they take opioids. People often call clinic after clinic before they get an appointment or find a doctor willing to help. This is not in patients’ heads. A new study now confirms it is a significant problem for people with chronic pain who need opioids. If they have to change doctors, they are in trouble.
The new study shows that almost half of all clinics in the US balk at treating chronic pain patients on opioids. Researchers at the University of Michigan ran the study. They used a method called “secret shopper.” A caller posed as a woman with chronic pain who took opioids. The team called 452 primary care clinics in nine states. They asked if each clinic was taking new patients.
Will a new doctor take you if you are on opioids for chronic pain?
If the clinic said “yes,” the caller said she had insurance and needed a new doctor to treat her chronic pain. Her last doctor had either retired or stopped prescribing opioids. So the researchers called each clinic twice, once for each story.
To the researchers’ amazement, 43% of all clinics said they would not prescribe opioids in both scenarios (early physician retirement or physician stopped prescribing opioids). Only about 32% said their primary care providers (PCPs) might prescribe opioids in these cases. Another 25% gave mixed signals.
The message is clear. Doctors shy away from patients on opioids. They turn them down without even looking at their health. The study also found clinics were twice as likely to turn a patient away if her last doctor had stopped her opioids. In those cases, clinics assume the person may be misusing opioids.
The study suggests that people with chronic pain face a significant challenge in finding proper care. Their odds drop even more if there is any sign they might abuse opioids. Health experts warn that this kind of refusal may significantly raise the risk that a patient turns to street drugs.
Researchers also looked at why some clinics balk at these patients. The answer: new legal rules, and fear of getting in trouble for prescribing opioids. The results match a study from 2019. That study found 40% of primary care physicians were highly reluctant to treat patients who need opioids for chronic pain.
This bias against opioid users is wrong, and it poses significant problems. This study aims to show that this bias exists, along with poor access to care. Health experts say that even if a person uses opioids for reasons other than pain management, they still need medical help. In fact, people addicted to opioids need more medical help, not less. Those are the patients primary care doctors must be treating.
Frequently asked questions
Do doctors still prescribe opioids for chronic pain?
Fewer are willing to. The University of Michigan ran a secret-shopper study of 452 primary care clinics in nine states. 43% said they would not prescribe opioids to a new chronic pain patient. Only about 32% said their doctors might. 25% gave mixed signals. A 2019 study found the same pattern: 40% of primary care physicians were highly reluctant to take these patients.
Why do doctors refuse new patients who take opioids?
Mostly fear. Clinics told researchers they worry about new legal rules and about getting into trouble for prescribing opioids. Many also assume a patient on opioids must be misusing them. Clinics were twice as likely to turn a caller away when she said her last doctor had stopped prescribing. That is because they read it as a sign of misuse, not a retirement or a policy change.
What happens when chronic pain patients are turned away?
Refusing care can push people toward illicit drugs. Health experts warn that turning away a patient on opioids raises the risk of that switch, even when the patient has a misuse problem. Misuse is not a reason to refuse care. People who are addicted to opioids need more medical help, not less, and they are exactly the patients primary care physicians should be treating.
Dr. Gurpreet Singh Padda, MD, MBA, MHP
