Finding a good primary care physician / GP can be tough, especially for those of with chronic conditions. People with chronic conditions often have complex care needs, multiple co-morbidities and need a supportive, caring doctor who has the patience to work through multiple issues. According to a new study, for people taking prescription opioids for chronic pain, finding a primary care provider is far, far harder.
In the study, conducted by researchers from the University of Michigan, researchers contacted 194 primary care clinics to find out whether the clinics would accept and continue prescribing opioids to new patients already taking long term opioids for chronic pain. The researchers posed as the children of patients with chronic pain who were taking opioids. The researchers also divulged that the patient was also taking medication for high cholesterol and high blood pressure, two conditions that commonly require management in primary care.
The results of the study were alarming: 40% of the 194 primary care clinics said they would not accept a new patient who takes opioids daily for pain, irrespective of the injury or condition they were taking opioids for, or what kind of health insurance they held.
Another 17% of the clinics said they required more information before deciding whether they would accept the patient, or schedule an initial appointment. After receiving the additional information requested, 1 clinic accepted the patient, 4 denied the patient, 20 stated they would schedule an appointment and decide after the initial visit and 1 asked for medical records to be faxed and they would decide from those.
Another 40% were willing to schedule an appointment from the initial phone call.
Larger clinics and those that offer safety-net coverage were three times more likely to accept patients who currently take opioids for chronic pain.
This shows that patients currently taking opioids are at a large disadvantage if they need to find a new primary care provider. It could be argued that these patients need primary care the most, as most have chronic conditions that require management and preventative care.
Having a primary care provider could enable them to receive information and referrals to other forms of pain management, or if indicated, help in tapering their use of opioid mediations.
“The findings suggest that access to primary care may be reduced for patients taking prescription opioids which could potentially lead to unintended consequences, such as conversion to illicit substances or reduced management of other medical co-morbidities,” concluded the Dr Lagisetty, the study’s lead researcher.
The team behind the study want to study the problem further and analyse the factors responsible, including the 2016 CDC opioid guidelines and policies, provider stigma against patients who take opioids, and provider fear of legal ramifications.
“Everyone deserves equitable access to health care, irrespective of their medical conditions or what medications they may be taking” says Lagisetty.
Personal note: I moved house almost 18 months ago. In my new area I was unable to find a GP who would take on my care, specifically because they would not take a patient who was taking daily opioid therapy for chronic pain. I saw 6 separate doctors at 4 medical practices. Ultimately I had to travel back to my old locale and my old GP to continue receiving care. Luckily its only around 20 minutes away, but on days when I can barely walk, driving for 20 minutes to my primary care provider is difficult to say the least. The stigma against people who take opioids for pain is not just a US phenomenon, its happening world over, even when the studies clearly show that the vast amount of patients on opioid therapy for chronic pain do NOT get addicted.