A recently released report by the University of Michigan (U of M) found patients on opioid medication across the U.S. are likely not receiving adequate care due to significant barriers to primary care and specialty pain care. The report said legislation is preventing current opioid users from finding care due to an unwillingness of physicians to accept new patients and other administrative barriers.
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Researchers at U of M audited primary care groups across the U.S. over a couple of years through calls as prospective patients and follow-up interviews with clinicians.
The report found 40% of primary care clinics were “unwilling to accept new patients taking opioids for chronic pain.” This percentage includes patients of all different types of insurance as acceptance rates did not differ by type of insurance.
Clinicians in follow-up interviews said they were hesitant to accept patients with opioid prescriptions due to the fear of liability and litigation, administrative headaches around managing the drugs, the stigma of opioid use, and the lack of reimbursements from insurance companies.
Pooja Lagisetty, M.D., senior author and assistant professor of internal medicine at Michigan Medicine, said:
“As more policies are implemented to reduce opioid prescribing, providers may be increasingly hesitant to accept new patients who have active opioid prescriptions due to increased administrative burden when prescribing and also fears around litigation. It is important for health care providers and policymakers to find the balance between avoiding overprescribing and restricting access to opioids to the point that it leads to uncontrolled pain and other unintended consequences for patients who depend on them.”
Patients also experienced barriers to specialty pain clinics. According to the report, 51% require a referral from a primary care physician which further extends barriers to patients who have trouble seeking primary care. Of the pain clinics audited, 48% also did not accept Medicaid increasing the barriers to care.
The report also found that 90% of pain clinics did not offer adequate multimodal chronic pain treatment, which provides a holistic approach to pain care including intervention procedures, combining medications, and behavioral health treatment. Lagisetty said:
“Evidence consistently shows that treating chronic pain effectively requires a comprehensive approach that goes beyond medications and also addresses other physical and behavioral treatments tailored to individual patient needs, but our research found that the majority of patients aren’t receiving such treatment.”
A recent editorial on Jama found an association between opioid dose tapering and increased risk of overdose and mental health crises. The authors said current policies discourage clinicians to provide adequate time to provide patient-centered care when it comes to tapering off opioid prescriptions.
The research team convened a panel of Michigan policymakers, stakeholders, and advocates with expertise in opioid treatment to identify and discuss necessary interventions to fix these barriers.