Updated: Sep 4, 2019
IN THE NATIONAL FIGHT against opioid abuse, policymakers and politicians have deployed a range of strategies, including curbing access to the powerful prescription drugs. The logic: Stop addiction before it starts by restricting the amount of painkillers a patient can take.
But a new paper published Friday presents strong evidence that opioid users who take the drug for chronic pain -- but show no signs of addiction -- are suffering harmful, potentially deadly consequences of the crackdown, and are at risk of becoming "opioid refugees."
Slightly more than 4 in 10 doctors' offices refused to take on new patients who need opioids to control pain, according to the analysis, published in the online Journal of the American Medical Association.
That reluctance, the paper argues, could lead patients who use the drug responsibly as well as those who are addicted to seek out other ways to manage their condition -- including illegal potentially dangerous substances like heroin -- and increases their risk of suicide.
The results "are concerning not only because they demonstrate how difficult it may be for a patient with chronic pain to find a new primary care physician, but it also raises questions about what happens next," says Dr. Pooja A. Lagisetty, an internist and researcher at the University of Michigan Institute for Healthcare Policy and Innovation. Lagisetty was the lead author of the paper, "Access to Primary Care Clinics for Patients With Chronic Pain Receiving Opioids."
"Where will these patients find relief for their pain? Will they turn to more dangerous illicit opioids?" says Lagisetty. If those patients can't get a primary care doctor, she adds, "who will manage their other medical problems such as their diabetes and hypertension?"
The situation is likely due to "a combination of factors," Lagisetty says, including "new regulations (on opioid prescriptions) that are time-consuming (for doctors) to comply with" as well as medical liability, and "stigma against patients with chronic pain."
Looking to examine whether medical practitioners were willing to take on patients who use opioids -- and continue writing prescriptions for them -- researchers contacted more than 190 doctor's offices and clinics in Michigan between June and October of last year.
Following a script, the callers told the medical-care provider that they were the child of a woman who needed a primary-care physician, but "before we get too far, is it OK if my mother takes opioids for pain?"
Of 194 clinics, "40.7% stated that their practitioners were not willing to provide care for new patients taking opioids," compared to 41% who were willing to schedule an initial appointment, according to the study. Seventeen percent of the clinics wanted more information before deciding whether to accept the patient, but after receiving the information only one agreed to treat her.
"Insurance status and whether the clinic provided for treatment of (opioid use disorder) were not associated with willingness to accept the new patient taking opioids," according to the study. "However, larger clinics with more practitioners and community health centers were more than willing" to take on an opioid-using patient.
The results could reflect "practitioners' discomfort with managing opioid therapy for chronic pain or treating patients with OUD as a result of pressures to decrease overall opioid prescribing," the study says. Further, "our study found that a low number of clinics provided any medications for treatment of" opioid addiction, "and a large number of front-desk staff at clinics … did not know whether their clinic offered OUD treatment."
Lagisetty found the results surprising "because I expected it to be around 25%" of clinics who wouldn't take on opioid-using patients. "Forty percent was much higher than I thought it would be."
For patients, "I think that is still really problematic," she says. "It's hard to build a trusting relationship with your doctor to treat your other medical conditions if you feel like your doctor is not willing to address your pain."
"As a primary care physician, I will often see new patients who say that their previous doctor just stopped prescribing opioids for them," Lagisetty says. "When I ask why, many will say that the doctor said it was a new 'policy.' We see stories about abandoned patients all over the news, and I also think we talk a lot about stigma against patients with addiction, but there is also stigma against patients with pain."
Joseph P. Williams is a news editor with U.S. News & World Report.
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