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Another way #opioid-related stigma hurts the overall health of our patients: #primarycare access is limited for patients taking opioids for #chronicpain, and further reduced for those with histories suggestive of aberrant use. https://ihpi.umich.edu/news/patients-who-take-opioids-pain-cant-get-door-more-half-primary-care-clinics 
about our new paper (1/8)
about our new paper (1/8)
>40% of primary care clinics are not willing to potentially prescribe opioids for a new patient already taking them for chronic pain. We've seen this in Michigan already ( https://ja.ma/2XVU3Zi ) and now in 9 states across the US ( https://doi.org/10.1097/j.pain.0000000000002145). (2/8)
We called every clinic 2x: simulating a patient 1) whose doc retired and 2) where the doc stopped prescribing without a reason. Included clinics (CA, MA, MD, MI, MS, NJ, OH, PA TX) all confirmed they were accepting new patients. 43% said "no" to prescribing in both calls. (3/8)
Why? Many reasons (administrative burden, overarching policy, etc.) were given and are found in prior work @NCMedBoard
But 25% of clinics changed their answer between the 2 calls, and they were 2x as likely to potentially prescribe when a doc had retired vs. just stopped. 4/8
But 25% of clinics changed their answer between the 2 calls, and they were 2x as likely to potentially prescribe when a doc had retired vs. just stopped. 4/8
Same clinic, 2 calls, & 2 different responses. What does this mean?At 25% of clinics, there was no overarching policy on opioid prescribing. Front desk staff were making decisions re: who gets appointments. Many factors could be at play--but stigma likely has a large role. (5/8)
Even if clinics think a patient whose prior script was stopped without reason is misusing opioids, denying care is the wrong answer. This is stigma about chronic pain ( https://pubmed.ncbi.nlm.nih.gov/26859821/ ), opioids ( https://pubmed.ncbi.nlm.nih.gov/31671303/ ), and #addiction ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6857667). (6/8)
If we are suspecting misuse, shouldn't we be more keen on giving an appointment, engaging patients in care, etc.?
Especially with x-waiver changes https://twitter.com/Surgeon_General/status/1349884265526386688?s=20, PCPs have an opportunity to engage in treating pain and addiction as necessary. (7/8)
Especially with x-waiver changes https://twitter.com/Surgeon_General/status/1349884265526386688?s=20, PCPs have an opportunity to engage in treating pain and addiction as necessary. (7/8)
Thanks to @Amy_Bohnert @Stephanie_Slat @itsjenthomas @MicheleHeisler @AdrianneKehne Kip Bohnert Colin Macleod @UM_IHPI @UMIntMed for their help with and support of this research, published in @PAINthejournal! (8/8)
