Prescribing Opioids: Guidelines Create Access Barriers for Chronic Pain Patients

In 2019, more than 20% of U.S. adults reported having chronic pain—22% of them were on prescription opioids for pain management. However, the growing opioid crisis in the country led several agencies, including insurance companies, to institute guardrails such as checks on prescription drug monitoring programs and limits on the dosage and/or duration of opioids. Additionally, the CDC has developed guidelines for primary care physicians (PCPs) in an attempt to dissuade overprescribing. 

While the volume of prescribing opioids has reduced, there is concern that physicians have stopped prescribing opioids even to those patients for whom the benefits outweigh risks. To make matters worse, many primary care clinics are hesitant to accept new patients who may be on long-term opioid treatment (LTOT) for their pain, which means patients are at risk of not having access to a PCP.

Surveys Highlight Physician Hesitancy Toward New Patients

40% of 194 primary care clinics in Michigan that were contacted in 2018 said that their clinicians would not accept new patients if they were receiving opioids for pain. While insurance type (private or Medicaid) did not influence a clinic’s decision, single-clinician practices were more likely to turn away patients. Community health centers and larger clinics with multiple practitioners were more open to accepting patients on opioids—larger practices are better equipped to implement new policies than smaller clinics.  

A 2018 survey by the North Carolina Medical Board among more than 2,600 physicians in the state found that:

• 26% physicians had stopped prescribing opioids to their chronic pain patients
• 21% had discharged or transferred their existing chronic pain patients 
• 13% had stopped accepting new patients suffering from chronic pain 

A broader multistate survey in 2019 evaluated 440 primary care clinics across nine states for their willingness to accept and prescribe opioids to a new LTOT patient. The survey found:

• 43% of primary care clinics did not want to continue prescribing opioids to new patients
  • However, some clinics were amenable to prescribe opioids after considering the patient’s situation, such as if their previous PCP had retired or had stopped prescribing opioids
• About 40% of clinics were unwilling to prescribe opioids at the initial point of contact

According to the study’s lead author, clinics often cited new policies around opioid prescription, fear of legal action, or administrative burden as the reason for denial. She emphasized the need to provide support and training to primary care clinics so they can successfully help patients who have potential substance use problems.

Patients Facing Harm 

Patients on prescription opioids may struggle to find access to primary care. Being turned away also leaves patients without the option for slow opioid tapering or access to nonopioid treatment options. This could prove harmful in that patients may turn to prohibited drugs or opioids. Even worse, they may be left to bear constant pain without relief, which can impact their ability to work or lead a normal life.

Stigma, bias, and provider fear around laws for prescribing opioids may be creating barriers for chronic pain patients in genuine need of that care.

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