Injured workers using opioids may struggle to find willing doctors

Individuals using opioids have difficulty finding a physician willing to take them on as a patient, and workers comp patients likely face similar barriers to care, experts say.

A University of Michigan study released in mid-July found that 40% of individuals taking an opioid for chronic pain were rejected as potential patients in group health.

Opioid-using patients in the workers compensation system face the same challenges in finding a doctor to take them on after an injury, and the statistics are likely no different in workers comp than the group health sector, said Dr. Steven Feinberg, a pain expert and founder of the Palo Alto, California-based Feinberg Medical Group.

“The problem is universal regarding physicians taking patients who are already on opioids,” he said. “Quite frankly, why would you want to take on a patient on opioids given the current situation?”

When workers comp doctors are presented with injured workers already on opioids for other issues, it places them in a catch-22, because if they continue to prescribe opioids to treat the new injuries, they may face scrutiny from medical boards, but if they begin a weaning program that the employee is against, they may face lawsuits, Dr. Feinberg said.

“You will have doctors that say ‘no’” to injured workers who are taking opioids, said Dr. Paul Peak, assistant vice president of clinical pharmacy for Memphis, Tennessee-based Sedgwick Claims Management Services Inc. “They’re hard cases to treat.”

Dr. Pooja Lagisetty, a general internal medicine physician at Michigan Medicine, Ann Arbor, Michigan-based University of Michigan’s academic medical center, and her research team used a “secret shopper” method and contacted nearly 200 primary care clinics who were accepting new patients at the time. The researchers posed as the adult children of aging parents scheduling appointments on their behalf. They told the clinics that their parents seeking new primary care physicians took medications for high blood pressure and cholesterol, as well as Percocet daily for managing pain from a past injury.

Of the clinics contacted, 40% said they wouldn’t accept the new patient. Of those that did not immediately reject the patient, 17% said they needed additional information before deciding whether to take on the patient, and two-thirds of those said the patient needed to come in for a preliminary appointment before the clinic would accept them as a new patient.

The researchers found no statistical difference in patient acceptance based on their insurance or whether the clinic was rural or urban. The study did reveal that larger clinics and those that offered safety-net coverage were three times more likely than others to accept patients who currently take opioids for chronic pain.

But workers comp doctors presented with some of these opioid-using patients may not even know about preexisting opioid use due to the disconnect between group health and workers comp, noted Dr. Peak. The comp providers in many cases are not the ones who prescribed the opioids, and once a patient is accepted, they’re tasked with the challenge of “trying to figure out how to treat them.”

“Once someone’s been on opioids — particularly long term — and if they have a new injury, their body already is sensitized,” making them more difficult to treat, Dr. Feinberg said.

It is more important than ever that prescribers in workers comp conduct a complete physical history and examination of a patient to determine the extent of past opioid use, why it was prescribed and what the previous prescriber has done, said Phil Walls, Tampa, Florida-based chief clinical officer for myMatrixx, an Express Scripts company.

Although Mr. Walls said he has seen doctors in the comp system be much more judicious about taking on patients using opioids, he questioned the accuracy of the University of Michigan study because of its reliance on phone calls vs. in-person visits to determine whether a provider would accept the opioid-using patient. Business Insurance followed up with Dr. Lagisetty but she did not immediately respond. Mr. Walls said he often hears from adjusters saying that their patient has called every pharmacy in the area to fill an opioid prescription and being declined because it “makes pharmacists very nervous asking about their inventory” of opioids.

“With that initial call, you’re already putting the prescriber on the spot,” said Mr. Walls. “I’m concerned that it might have biased the study.”

But even if just 20% of those patients have a true barrier to primary care because of their opioid use, “that’s still a significant impact,” he said.

Patients being bounced between physicians because of their history of opioid use can also affect the quality of care, said Dr. Lagisetty, who is completing a new study that probes why some clinicians are willing to accept opioid-taking patients and what resources those providers may have to overcome the administrative burdens of taking on patients who say they need opioids.

Dr. Lagisetty noted that some patient advocates have blamed the 2016 chronic pain treatment guide from the Centers for Disease Control and Prevention as “swinging the pain-treatment pendulum too far away from prescription opioids” — an assertion that Mr. Walls shares.

“I think the perception is that (prescribing opioids) is increasing liability, but I think if a prescriber is well-versed in opioid management and he or she is following guidelines as they were intended … I think that increase in liability should be minimal,” he said.

This article was first published by Business Insurance.

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