Examining Access to Primary Care for People with Opioid Use Disorder

A new study released last week in JAMA Network Open shows that family physicians were almost three times less likely to offer a new patient appointment to a person with opioid use disorder (OUD) than a person with diabetes. These findings suggest that physicians’ discretion in accepting new patients contributes to poor access to primary care for patients with opioid use disorder, highlighting a need for health system change.

The study’s lead author – Dr. Sheryl Spithoff, family physician and researcher, Women’s College Hospital – tells us about this research and its implications for the healthcare system.

Dr. Sheryl Spithoff wearing a white t-shirt and smiling
Dr. Sheryl Spithoff, study lead author, family physician and research at Women’s College Hospital

Tell me about your research on access to primary care for people with OUD vs. people with diabetes. What did it focus on? What were the findings?

The objective of our research was to determine whether family physicians were less likely to accept new patients with OUD than those with diabetes. The focus of our primary analysis was comparing the proportion of people with OUD offered a new patient appointment versus those with diabetes. We found that family physicians were almost three times less likely to offer a new patient appointment to a patient with OUD than with diabetes.

A women concern on the phone with the caption "patients with opiod use disorder and three times less likely to be offered a new patient appointment with a family doctor compared to people with diabetes"

Were any of the findings particularly surprising for you or your team?

The findings were disappointing but not surprising – our previous research, as well as research done by others, showed low rates of attachment to primary care for this population. Our findings also align with surveys of physicians. Physicians report being reluctant to accept patients prescribed opioids into their practices. They report concerns that they do not have the skills or time to care for people with addictions. They also report high levels of stigma against people with addictions, similar to that of the general population.

Why is this research important?

People with OUD are a growing population, and a large proportion of them have chronic health conditions yet they have poor access to primary care. Our work demonstrates that family physician discretion in accepting new patients contributes to the low rates of attachment to primary care, pointing to the need for health system changes.

What are the implications for people with opioid use disorder and, at a broader level, the healthcare system?

People with OUD are less likely to be enrolled with a primary care provider and therefore less likely to receive high-quality primary care, including appropriate preventative screenings and monitoring. Policymakers and organizations representing physicians should develop policies that ensure individuals within a certain catchment area are automatically eligible for a primary care provider. For instance, “meet and greets”, if used to screen out “undesirable” patients, are problematic

Family physicians should have adequate training, such as anti-oppression training and training on caring for stigmatized populations, resources and financial compensation to care for patients with complex needs.

What are some potential reasons physicians may not take on a patient with an opioid use disorder?

  • Physicians express concerns that they do not have the skills to care for patients with opioid use disorder.
  • Physicians may feel that they’re not appropriately compensated for this complex patient population.
  • Physicians may be biased against individuals with addictions.

Thank you, Dr. Spithoff!