Taking Prescription Opioids Could Limit Primary Care Access

Access to primary care may be reduced for patients taking prescription opioids, according to a study published online in JAMA Network Open.

Pooja A. Lagisetty, M.D., from the University of Michigan in Ann Arbor, and colleagues conducted a telephone survey using simulated patient calls to assess practitioner willingness to accept and continue prescribing opioids to new patients with pain and whether this willingness differs across payer types. Calls to primary care clinics that served a general adult population in Michigan were made between June 22 and Oct. 30, 2018, to determine if they accepted both Medicaid and private insurance and took new patient appointments. Ultimately, 94 clinics were randomly assigned (according to insurance type) to receive calls from research assistants posing as children of patients with Medicaid, while 100 clinics received calls from supposed children of patients with private insurance.

The researchers found that overall 40.7 percent of clinics stated that their practitioners would not accept a new patient who was currently taking opioids for chronic pain. Seventeen percent of clinics requested more information before making a decision. Clinics with more than three practitioners were more likely (odds ratio, 2.99; 95 percent confidence interval, 1.48 to 6.04) to accept new patients currently taking opioids, compared with single-practitioner clinics. There were no differences in access based on insurance status (odds ratio, 0.92; 95 percent confidence interval, 0.52 to 1.64) or whether the clinic offered medications for opioid use disorders (odds ratio, 1.10; 95 percent confidence interval, 0.45 to 2.69).

"The findings suggest that access to primary care may be reduced for patients taking prescription opioids, which could lead to unintended consequences, such as conversion to illicit substances or poor management of other mental and physical comorbidities," the authors write.

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