leagues 1 on their work on trust and the doctor-patient relationship in patients on chronic opioid therapy. There are, however, 2 issues that I would like addressed. First, according to this article, when discussing the study population, "the remaining members received care from community doctors, about whom little information is available"; this point was not acknowledged as a limitation of the study. This is vital because the strongest predictors of trust in a doctor-patient relationship are

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... he doctor's personality and behavior and patients' trust has been shown to be affected by doctors' interpersonal skills and style of communications. 2-4 Could factors other than the opioid reduction initiatives have contributed to the differential trust level between the 2 groups? Second, studies have shown that the type of health insurance affects patients' trust. Insurance plans with more choice of physician engender more trust. 3, 5, 6 Given that all study participants were from Group Health Cooperative, a monolithic group, and there was no information given on the plan types, the generalizability of the results to the general population on chronic opioid therapy is not known.