Balancing Opioid Policy and Pain Management

March 2, 2018

Is Washington finally ready to address the nation’s opioid crisis in a meaningful way?

Thursday marked the White House Opioid Summit, which welcomed 200 affected Americans to discuss the crisis with Cabinet members.  President Donald Trump declared the opioid abuse epidemic a public health emergency last fall.

The White House’s summit came on the heels of congressional action earlier this week.  Dubbed “CARA 2.0.,” a bipartisan bill introduced in the U.S. Senate would:

  • Allow nurse practitioners to prescribe anti-addiction medication known as buprehenorphine
  • End limits on how many patients physicians can treat with buprenorphine
  • Better fund and train first responders to use of naloxene, a drug to reverse opioid overdoses
  • Require physicians to use prescription drug monitoring programs
  • Limit initial opioid prescriptions to three days, except for patients in hospice care or those with cancer or chronic pain.

Policymakers seem serious about dealing with the opioid crisis, which kills an estimated 115 Americans every day.  But will their methods address the root of the problem?

Effective Opioid Policy & Patient Care

Consider the limit on initial opioid prescriptions.  As addiction psychiatrist Sally Satel, MD, argues in a recent POLITICO article, patients whose doctors prescribe them opioids for pain seldom become addicted.  “Those who do become addicted and who die from painkiller overdoses tend to obtain these medications from sources other than their own physician,” Satel explains.

Granted, addressing overprescribing for post-operative or short-term medical issues can help stem the tide of excess opioid pain pills that get stolen or shared.  But the rise in heroin and illicit fentanyl-related overdoses suggests that reducing the number of prescription opioids in circulation is not a standalone solution, Satel argues.

And what of patients in pain?

In a recent New England Journal of Medicine article, three physicians raise concerns about ensuring that physicians and patients can still manage pain appropriately.  “As the pendulum swings from liberal opioid prescribing to a more rational, measured, and safer approach,” the authors explain, “we can strive to ensure that it doesn’t swing too far, leaving patients suffering as the result of injudicious policies.”

One important factor is better access to balanced pain management.   The approach allows patients and their doctors to select from a range of treatments, both pharmacologic and non-pharmacologic, to achieve a balanced, personalized course of care.  Elements might include nerve blocks and IV acetaminophen for patients with acute pain, or physical therapy and chiropractic care for chronic pain.

Balanced pain management is an ideal replacement for the one-size-fits-all approach fostered by health insurance plans that make low-cost prescription opioids more accessible than alternative or comprehensive approaches to pain.  As lawmakers impose limits on opioid prescribing, health plans and hospital administrators would do well to balance the move by making other pain management methods more accessible.

To learn more about personalized pain treatment, watch “Understanding Balanced Pain Management.”

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