Pain Patients Taking Opioids Discriminated Against At Primary Care Clinics, Study Finds

by DailyHealthPost Editorial

A very comprehensive “secret shopper” study by the Michigan Medicine Center determined that nearly half of the primary care clinics in the country don’t allow in opioid-taking patients. The study was published in the Pain Journal and included data from 452 clinics in 9 different states. 

The lead researcher in the study, Pooja Lagisetty, M.D., M.Sc. from the University of Michigan’s academic medical center confirmed that the results were due to a stigma among healthcare professionals toward patients who take opioids. Regardless of whether the patients are taking opioids for chronic pains or not, many medical professionals seem inclined to assume an opioid addiction and just close the door to such patients.

Stigma around substance use.

Dr. Lagisetty said she hopes her and her team’s research will help primary care clinics take a better look at their practices and reexamine their biases.


“We need to make sure we’re training prescribers and their teams in addressing the systemic biases that this research highlights,” said Lagisetty. “We shouldn’t even be thinking about the reason that patients are giving when they seek to access care.”

“Even if you think that someone is using opioids for a reason other than pain, or that long-term opioids are not an effective pain care strategy, those are exactly the patients we in primary should be seeing,” she added. “Restricting their primary care access limits their ability to engage in pain-focused care and potentially addiction-focused care.”

Lagisetty went on to explain that these practices are not only harmful to the patients but also worsen the already deep systemic stigma toward opioid users. 

This isn’t the first time Lagisetty and her colleagues have yielded similar results. That study was conducted in only 194 clinics, however, and took place only in Michigan while the new study expanded to 9 different states.

How was the study conducted?

The methodology behind the “secret shopper” tests was very simple – each of the 452 clinics was contacted by 2 separate callers with a significant window of time between them. Both callers were always female and were asking whether the clinic was taking in new patients. The caller would always say that she is covered by a major insurer in the area and that she’s been taking opioids for pain in the last few years.

The difference between each clinic’s two calls?


The first caller would say that she’s looking for a new provider because her previous provider has retired.

The second caller would say that she’s looking for a new provider because her previous provider has stopped prescribing her opioids and she’s looking for a new primary care clinic that prescribes opioids. 

Of all 452 clinics, 43% (193 clinics) refused service to the second caller. 

“This suggests that many clinics are likely just shutting their door to any patient needing an opioid prescription despite the reason for needing a new provider,” said Lagisetty, herself a member of the U-M Institute for Healthcare Policy and Innovation. “Clinics often stated to the patient that this was due to new policies, fear of legal ramifications, or administrative burdens.”

This is both disheartening and damaging given that opioid addicts need help and not to be ignored by healthcare professionals. Lagisetty also went on to explain that there are barriers to treating opioid addiction in primary care clinics such as lackluster special training. According to Lagisetty, healthcare providers should be trained to prescribe buprenorphine to patients with opioid addictions and opioid use disorders.

How can this stigma change?

There are some positive signs that things will improve. It’s expected for certain federal requirements to get relaxed and improve things. But even then, healthcare providers will need to receive training for providing the right kind of care to patients with opioid problems.


Of the remaining 57% of clinics that didn’t turn down the second caller, 32% said that they would schedule an appointment with the patient and the primary healthcare provider would prescribe them the opioid they need.

The other 25% of the “positive” 57%, however, sent “mixed signals” according to the study. Even though they still scheduled appointments with both patients, they showed hesitancy with the second caller, and multiple calls were often required.

“In these cases, where clinics gave different answers depending on the scenario presented, it is harder to argue that stigma around opioid use, pain, and addiction is not playing a role in clinic decision-making,” said Lagisetty.

It is clear that there’s a lot of work to be done if the opioid epidemic in the U.S. is to be stopped. With more than 750,000 people in the country dead from drug overdoses since 1999 primary care clinics will need to improve their service. There have been some improvements in the statistics with 13.5% fewer people dying from a prescription opioid-related overdose in recent years but there’s still more to be done.