GAO Wants Medicare to Do More To Limit Opioids

GAO Wants Medicare to Do More To Limit Opioids

By Ed Coghlan.

Medicare says it needs to expand oversight efforts to reduce the risk of harm and has released a three plan idea that one chronic pain advocate calls a “dangerous and ill-begotten document that transforms the CDC policy into a framework of dose management that has nothing to do with healthcare or patients.”

For Terri Lewis, PhD it is something the chronic pain community should fight.

More than 14 million people received opioid prescriptions in 2016 through the Medicare drug benefit program, Part D. However, the GAO claims that Medicare “lacks information on most beneficiaries at risk of harm.”

The U.S. Government Accounting Office (GAO) does not believe that Medicare (The Center for Medicare and Medicaid Services/CMS) capture data on an even larger population of beneficiaries potentially at risk of harm from high doses of opioids.

The recommendations are:

1.       The Administrator of CMS gathers information over time on the number of Medicare beneficiaries at risk of harm from opioids, including those who receive high opioid morphine equivalent doses regardless of the number of pharmacies or providers.

2.       The Administrator of CMS requires its contractor, National Benefit Integrity Medicare Drug Integrity Contractor, to identify and conduct analyses on providers who prescribe high amounts of opioids separately from providers who prescribe high amounts of any Schedule II drug.

3.       The Administrator of CMS should require plan sponsors to report to CMS on investigations and other actions taken related to providers who prescribe high amounts of opioids.

“We need to demand in no uncertain terms that this document be recalled or retracted,” Lewis said.

For a link to the GAO Recommendations which were issued earlier in November, go here.

 

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Authored by: Ed Coghlan

There are 31 comments for this article
  1. Tim Mason at 10:47 pm

    I agree Linda. I am sick of it as well. Facts have already been gathered. What we Know:
    1) The limits were guidelines not laws
    2) Addiction begins in adolescence
    3) The War on Pain Patients is fueled by Rich Insurance Salesman
    4) Pain Physicians were not consulted nor had input by CDC
    5) FDA did not approve the Guidelines
    6) The real crisis is heroin not prescription medications
    7) Real chronic pain is complex and absolutely requires long term opioid therapy
    8) Alternate chronic pain therapy for elderly people is dangerous and unaffordable
    9) Those unaffected by chronic pain do not care (lack of empathy)
    10) Patients and the doctors that treat them are being abused and mistreated by our Government.

  2. Brian Dickerhoff at 10:54 am

    [ All this info. In regards to denial of opiods to patients who need them makes me furious as a patient. WHAT CAN I DO? ]
    I Agree !!! How do we make people hear this before it gets any worse ? ?
    There has to be a way to publicize this ? Is there a Congress Member that agrees with us?
    If not then we petition the ones that don’t, Somebody has to know a good way to proceed !
    Brian D.

  3. Sheldon at 9:43 am

    All this info. In regards to denial of opiods to patients who need them makes me furious as a patient. WHAT CAN I DO?

  4. Linda at 8:10 am

    I swear, whenever the GAO is mentioned, all I can think about is that disgusting thief sitting in a giant bubble bath holding a glass of wine, all on the tax payers hard earned money and it makes my blood boil that they would have their dirty hands anywhere to do with pain management. Opiod management!

    The whole deal should be left up to the professionals hands only – doctors. And if they do wrong, then laws already on the books should be enforced for those doctors, if they are flat out criminals.

    Sick of the whole thing. Sick of not being able to be heard by just one person in the power position.

  5. HAZZY at 2:02 pm

    I SURE TELL YOU, I HAVE NEVER BEEN SCREWED WITHOUT GETTING A KISS !!!! THAT IS WHAT OUR GOVERNMENT IS DOING TO US. ITS FUNNY, BUT MY LAST PAIN PRESCRIPTIONS WERE APPROVED BY MEDICARE !!!!! HHHHMMMMMM

  6. HAZZY at 10:30 am

    IAM A DISABLED VETERAN, I CAN’T GET MY PAIN MEDS FROM THE VA, AND THEY ARE THE ONES THAT SCREWED MT UP !!!!!!!!!!!!

  7. Tim Mason at 2:10 pm

    I have been an AARP member for over 8 years. They wrote a bad article about opioids about 3 issues ago.
    In the light of GAO, I am thinking of drafting an article for entry into their magazine.

  8. Brian D. at 11:42 am

    How can we all contact the ‘Powers that be’ in a mass effort to convince them that this is Nt an addiction issue and they need to crack down on ILLEGAL drug sales including heroin and the sale of scheduled opiates ?
    Is there a Email that we can all sign ? We need the Media to get off this Low Hanging Fruit that they’ve been offered to warm the hearts of america that leads them to conclude that Congress is saving us all from destruction .
    Where are the stories about Pain Sufferers being denied they’re rights? I cannot get off my back without medication.

  9. Tim Mason at 7:20 pm

    http://www.healthnewsreview.org/2016/01/the-opioid-crisis-facts-that-news-coverage-is-missing/

    They admit it is heroin not prescription drugs that is a problem. https://www.yahoo.com/news/the-campaign-heats-up-to-make-overdose-fighting-naloxone-available-everywhere-135455251.html

    They admit it is heroin not prescription drugs that is a problem.

    Pain in the aging population https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096211/

    Chronic pain patients do not get high on their medications.
    I my have posted this before, but it bears repeating as many times as it takes.

  10. Rather Hopeless at 9:11 am

    I completely agree with those speaking out for the legalization of euthanasia. I just read a piece from approximately a year ago arguing that it should either be allowed for all or none. As an added “bonus,” perhaps it would be approved more quickly than anything else we’ve been striving towards/fighting for, maybe even get some media coverage.

  11. Glen at 8:45 pm

    The FDA and CDC have been publishing False reports and statistics this entire time! Less than 2% of Legally prescribed opiod meds are abused in any way! That still leaves over 2 million people illegally abusing or selling it. Yet Well over 100 million people are being Forced to suffer horrifically! The FDA, CDC, and big pharma are making a Lot of money off this False epidemic! We have an addition epidemic. The CDC list’s All Street drugs (except cocaine) as opiods! This way they can manipulate and deceive Everyone into thinking it’s only about pills to further their agendas. Since they have started 3 years ago the overdose rates have only gone UP! Obviously, with So Few chronic pain patients still able to get any type of pain relief from meds why hasn’t it gone so far down that it’s not a problem? Because the pills are suck a Small percentage of it! The street drugs that has been imported here (yes, even by our own government) has increased along with the overdose rates. Only 4.5% of overdoses include prescription pills. That’s not saying how much of this 4.5% is from a chronic pain patient committing suicide because they are loosing their last option. Most Don’t want to take any kind of pills, but they have to just to function! Most refuse to go to the street drugs for pain reduction ( plus they wouldn’t know how to use the crap)! Their only option is suicide. The suicide rate for chronic pain patients has skyrocketed because of our government!

  12. Losing Hope for USA at 7:53 pm

    Portugal is looking better and better. What kind of country are we becoming? Why blame drug addiction on those who use narcotics for chronic pain? As if we are somehow responsible for others behavior. We are not the prescribers, we are people who through no fault of our own have chronic pain due to disease, auto accidents, failed surgeries to name a few and are trying to live a better life with our pain controlled as best as it can be. Why are we targeted?

    I think it’s because we prove that you can live a better, more healthy life with the use of narcotics. We use them as directed, don’t get high and these drug abuse zealots can’t stand this. They claim narcotic users are all addicts, are addicted after one use, must constantly escalate the dosage, believe they are useless for pain control and that we take these medications to get high. It is useless to talk to us as we are addicted and will say anything to keep our habit going. This is the way they put it to Congress. I believe they want Federal money for addiction rehab. Many own rehab facilities which are even traded on the stock market. They are pushing this as a revenue producer and a growth industry. We are being manipulated.

    Here is a short article about Portugal’s drug policy. The statistics prove we are dealing with addiction the wrong way. Criminalizing rather than treating addiction as a public health problem. The US believes in punishment not treatment. Look where the money goes, to prisons, law enforcement, lawyers, judges. This is not about rehab, it’s about throwing people away and breaking up families. The past 50+ years show this approach does not work.

    6 incredible things that happened when Portugal decriminalized all drugs

    Business Insider, Apr. 26, 2016
    by Drake Baer

    In July 2001, Portugal decriminalized all drugs, including marijuana, cocaine, and heroin.

    The possession of small quantities of those drugs was shifted to a public-health — rather than criminal — issue.

    Rather than getting arrested for a small amount, you get sent to a “dissuasion commission,” where a doctor, lawyer, and social worker prescribe treatment or give you a fine. Mic’s Zeeshan Aleem reports that people walk away without a penalty most of the time.

    Here’s what the data says about Portugal’s decriminalization:

    • Drug-related HIV infections have plummeted by over 90% since 2001, according to the drug-policy think tank Transform.
    • Drug-related deaths in Portugal are the second-lowest in the European Union. Just three in a million people die of overdoses there, compared with the EU average of 17.3 per million.
    • The number of adults who have done drugs in the past year has decreased steadily since 2001.
    • Compared to rest of the EU, young people in Portugal now use the least amount of “legal high” drugs like synthetic marijuana, which are especially dangerous.
    • The percentage of drug-related offenders in Portuguese prisons fell from 44% in 1999 to 21% in 2012.
    • The number of people in drug-treatment increased 60% from 1998 to 2011 from 23,600 to 38,000.

    Portugal’s decriminalization came about because the country was in crisis. In 1974, Portugal’s dictatorship fell after a coup that became known as the Carnation Revolution. The country soon became flooded with drugs. By 1999, a full 1% of the population was actively addicted to heroin, and the country had the highest rate of drug-related AIDS deaths in the EU.

    Shifting drug use from a criminal to a public-health problem was a bid to reverse that trend.
    “We figured perhaps this way we would be better able get things under control,” drug policy architect João Goulão told Der Spiegel in 2013. “Criminalization certainly wasn’t working all that well.”

    Goulão has been careful to say that you can’t evaluate decriminalization in isolation — it was all part of Portugal’s robust rollout of an expanded welfare state. Portugal isn’t alone in shifting the war on drugs to something less combative. The Netherlands has a “tolerance policy” of soft drugs like marijuana, which can be sold in regulated cafes. Uruguay became the first country to fully legalize marijuana in 2013, and marijuana is slated to go on sale in regular pharmacies in the second half of 2016. Four US states have legalized recreational marijuana, with Oregon raking in tax money from doing so.

  13. Terri Lewis at 5:25 pm

    HHS OIG has also issued an even more onerous document directing Medicare Part D to reduce prescribing for opiates.

    Both documents make it entirely clear that persons who need palliative care are not accounted for in the grand scheme of things.

    Nobody is going to do this for us folks.

    Through NPR, I issued a list of 5 things you can do to get your house in order. Nothing changes until we do. If you want this to change, you must work for it. It is not somebody else’s job.

    If you prepare, we can lead you through this. If you don’t nobody can help you. The choice is entirely yours.

    Simple as that.

  14. Jim Moulton at 2:53 pm

    If they are not going to let you get pain medicine to treat your proven pain, which is not going to heal or surgery is not going to fix, they should let you have euthanasia.

  15. Kim at 1:21 pm

    I pray people in charge of Medicare realize they have allot of other major issues to address. Being horrifically ill & unable to protest outside my home I did write to my local government & president Trump’s office regarding the CDC guidelines & I will write to protest this issue. I hope everyone being effected by this will do the same.

  16. Patricia Bowles at 12:54 pm

    I spend more time thinking about how to take my life – than living my life – because I am being cut down on my medications and articles like this scare me as I recently retired and if Medicare does not cover my medications or I am unable to get them I am screwed. I spent years in pain before finally getting medications which took years of procedures, surgeries, injections, medications with horrible side effects; and I tried numerous alternative methods spending thousands. Narcotic medications allowed me to continue my career for an additional 12 yrs and now that I am retired after 45 yrs of working I am in constant fear and my pain has escalated.
    Why are the big drug companies not paying for outside companies to do large studies with chronic pain patients & show the stats that prove most addicts were NEVER given a legal prescription for pain medications. The stats the CDC used was highly skewed, biased data from PROP & based on opinions from people like Kolodny. Why are non of the larger associations getting accurate information to the media so they – especially CNN – stops saying that two thirds of all overdoses are due to prescription drugs – it is a lie. Why are the autopsies not printing the truth?

  17. Tim Mason at 12:53 pm

    Skeeter, You are justified. Your dosage increased over the years because you grew older and your condition worsened. What happened you ask?
    The media, in their zeal for articles, TV talk shows, etc., in order to increase their profits thru readership depicted the pain patient as an addict. Bad statistics spread like a virus. What we have is a bad media epidemic. Seventy five (75%) of TV, magazine and newspapers BELIEVE what they read. See these links below.

    http://www.healthnewsreview.org/2016/01/the-opioid-crisis-facts-that-news-coverage-is-missing/
    Drug abuse by age. https://www.samhsa.gov/prescription-drug-misuse-abuse/specific-populations

    They admit it is heroin not prescription drugs that is a problem. https://www.yahoo.com/news/the-campaign-heats-up-to-make-overdose-fighting-naloxone-available-everywhere-135455251.html

    The sin of GREED is driving all of the bad information. Doctors which have spent their 2 decades studying to help people with chronic pain are threatened by DEA agents with 12 weeks training.
    Sick Grandmaw, Grandpaw, Mom and Dad, sick brothers and sisters do not stand in the way of the almighty dollar.
    Karma is for real. These people do not realize how many people they are hurting, how many are succumbing to their once controlled pain.
    Pain, being subjective, can only be understood by those that experience it or care for a family member that sets on the side of bed crying in tormenting pain.
    Hang in there. The ship of hope is finally coming out of the doldrums. It may not be able to turn 180 degrees in the current weather but the currents are changing.

  18. Tim Mason at 11:26 am

    I visited the GAO link. What is their definition of Harm? Geriatric patients are the least likely to fall victim to addiction. Addiction is see is a much younger age group that steal from the elderly and legitimate patients.
    This type of crime is on the rise since the Pain Management exit strategies are working very well the weed out the drug seekers. You don’t see reports about how well the PM clinic is doing in this regard.
    Reducing pain medicine from chronically ill elderly people is Elder Abuse.
    We need a new watch dog for this class of people where cost savings is not the bottom line..

  19. Denise at 10:50 am

    We need to come together! This has nothing to do with our protection..but more to do with there pockets. Scream and scream loud!! I have written the white house twice, and have been spreading on pain sites. But we are going to have to get the attention of the President, he is being fueled by Chris Christy! This man is spear heading the leach mob!

  20. Henry Goertemiller at 10:31 am

    First the good politicians in Ohio forced my pain management doctor to close his practice when they had Medicaid stop paying for office visits. I’ve lived with nerve damage in my spine for 16 years. With medication I was able to work and care for my wife, who after four years battling the disease, died last May. I have taken pain meds for 16 years since nothing else worked lik PT, epidurals, acupuncture, etc. I never took more than was prescribed, was subjected to urine tests and pill counts. Never failed any test. Now no doctor will prescribe these meds since they are afraid they’ll lose their license. At 78 I have lost hope to lead a normal life and take care of the basics of living alone. Sad way to end up when I did nothing wrong.

  21. Bob Schubring at 10:19 am

    I truly wish people in our community were better informed about how our nation’s legal system actually works. The linked GAO document, http://www.gao.gov/products/GAO-18-15?mobile_opt_out=1#summary_recommend is a letter answering a request by two Senators. The two Senators asked GAO a question and the GAO wrote this 26-page letter to them, answering their question.

    The GAO document is not a regulation, regulating how Medicare ought to conduct business.

    It is up to the two Senators to write legislation on that, or else, to ask the Social Security Administration to write a proposed rule, answering the GAO’s 26-page letter.

    Our response to this challenge requires that we contact the two Senators who asked GAO for the 26-page letter, and tell them why we think there’s something missing from the 26-page letter.

    Since the Senators’ web sites may not take email from people who live outside their States, a signed letter written on paper and mailed to them, is what will actually get their attention. Also useful are telephone calls to their staffs. Ten people took the trouble to write to NPR, reacting to the news of the GAO report. If each Senator got 10 phone calls from us, their staff would begin to comprehend that serious pain is a serious problem.

    Our confusion about who in the Government actually has authority to do things, and who is simply expressing an opinion or answering someone else’s question, makes it hard for us to take appropriate action.

    The Senators who asked the GAO the question, to which GAO wrote this 26-page answer, are
    Senator Pat Toomey,
    248 Russell Senate Office Building
    Washington, D.C. 20510
    Phone: (202) 224-4254
    Fax: (202) 228-0284

    and

    Senator Tim Kaine
    231 Russell Senate Office Building
    Washington, D.C. 20510
    Phone: (202) 224-4024
    Fax: (202) 228-6363

    Senator Toomey represents Pennsylvania. Senator Kaine represents Virginia. When writing them, please explain how pain is disabling and pain medicine restores your ability to function. You have a right, under the Americans With Disabilities Act, to function the best way you can, and it is unreasonable to take away a medicine that you need to function. Most addicts become addicted in their teens and early twenties. Addiction in senior citizens is extremely rare. CDC Guidelines, written in secret by a group of experts on teenage addiction, who were entirely unfamiliar with treating pain in senior citizens on Medicare, are not useful for determining who is at-risk of addiction, because the Guidelines did not take into account the other drugs commonly abused by teens such as methamphetamine, which play a role in causing opioid addiction. Seniors on Medicare don’t take methamphetamine and go to all-night rave parties. The CDC should have used some common sense and figured this out. Please remind the two Senators that the CDC’s failure to invite pain experts to draft the Guidelines, resulted in bad Guidelines lacking in common sense, that should not be the basis of federal restrictions on pain treatment for seniors.

  22. Eleanor Drewniak at 9:20 am

    I suffer with chronic pain from several health issues. Before pain medication I was in constant pain which eliminated my social activities. Work became so difficult the pain affected my ability to be accurate and productive. I was living a nightmare. I was referred to pain management. Everything possible was tried before opioid medication was prescribed. I, along with so many chronic pain sufferers, am not the stereotype of a drug addict. Pain medication was prescribed in the lowest doses possible until I found enough relief from my pain to have an active life again. I am limited, but not bedridden. I am so frightened to be in agonizing pain again because well meaning people think everyone that takes opioids wants to stay high and be an unproductive member of society.

  23. Janet Wilson at 8:58 am

    Why don’t you just kill me fast. Pass a decent euthanasia law like Holland where you don’t have to be terminal. Don’t make me do it myself.

  24. Cheri Furr at 8:40 am

    This is a death sentence for all chronic pain patients. PLEASE HELP US FIGHT THIS!

  25. Stephanie Scarbrough at 8:25 am

    Incredibly wrong… they’re demonizing chronic pain patients and their physicians! This nonsense has got to stop!!

  26. In Pain at 6:10 am

    What can we do about this? I’m outraged that Medicare patients are going to be targeted like this. It’s bad enough having chronic pain and trying to get medicare benifits in the first place, now they’re demonizing us and treating us like junkies. Disgusting.
    Tell us what to do? Contact the GAO?

  27. Karen C. at 6:07 am

    Should we email or call them? I imagine some of us will be afraid to leave our email address in fear of being targeted. Will a phone call be enough? What about using #67 when we call?

  28. Tim Mason at 5:54 am

    Pain in the aging population https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096211/

    Elderly pain undertreated. https://www.ncbi.nlm.nih.gov/pubmed/19459714

    Pain treatment in the Elderly https://medlineplus.gov/magazine/issues/fall11/articles/fall11pg15.html

    The three links above offer insight in pain of the elderly. Addiction rates of this group are reported to be > 0.1%.
    Medicare recipients have worked their entire lives doing jobs when words like ergonomics and personal protective equipment (PPE) were not even buzz words.
    The opioid crisis as it relates to physicians and patients is pretty much a hoax driven by greed and cost cutting tactics.

    The risk of addiction for someone in their mid to late 60’s is a non-issue. Most of us have geriatric doctors that look after our medications.
    Have you ever wondered why prescriptions of all kinds are formulated at various dosage levels? It is because we are different in our physical attributes.
    I recall working for a compounding pharmacy and a prescription for Skelaxin was written for a frail aging woman. The tablets were large and the dosage two high for her size and weight.
    I ground the tablets up into a fine powder and using a manual encapsulater to formulate a dosage that her doctor prescribed.
    Diabetics calculate their insulin units daily.
    Illness noes not exist under a bell shaped curve. Pain certainly does not.
    Variations in opioid medications exits for a sound scientific reason.

  29. Skeeter Langley at 4:34 am

    This is getting crazy, they are putting us chronic pain suffers that rely on these medications in serious danger. They are going to force some patients to turn to black market illegal drugs turning them into criminals. And some of them to take even more drastic measures like ending their pain and suffering for good.
    How in the world did we end up here? I have been on opiates for almost 14 years and on the same dosage for over 10 years and now they are telling me that I am taking to high of dosage. Who is making these decisions? Are they consulting with any pain management Doctors? Most people that have a true reason for taking these medications do not abuse them, like myself I am terrified of running out early. So no matter how much break through pain I have I never take any extra. What I am currently taking now i get by enough to function but my new pain management Dr wants to take away half and it scares me to death.
    I’m ready to fight but I’m not sure how or what to do.
    I have RSD/CRPS I’ve had it for a little more than 14 years.

  30. Beckyf at 4:14 am

    Again, this sounds like high and mighty people who are healthy, misinformed about people who are trying to live, our chronic pain patients.
    Does anyone know what Ehlers Danlos Syndrome is? It is a painful genetic condition. It cannot be fixed.
    Sounds to me GMO and all the others who don’t care about those suffering need to institute assisted suicide to be legal. It is the least they can do for people they want to take away what meds they barely get by with as it is.
    Ehlers Danlos people do not absorb meds like others. They need more than some.
    Idiocy is rampant in this country.

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