By BJ Cavnor.
In a move that’s left patients and doctors asking why, the Oregon Health Authority’s (OHA) Health Evidence Review Committee (HERC), are currently considering a proposal to severely limit access to opioid pain medications for Medicaid patients. Although officially this is being done to improve the health of patients by offering treatment alternatives it seems obvious that once again patients with chronic pain are being classified as addicts and blamed for the current drug crisis.
The new rules being discussed, known as Guideline Note 60, would limit new opioid prescriptions to a maximum of 90 days, and require anyone currently taking opioid medications to taper (or reduce) and discontinue the medications completely within a specified time frame.
OHA would instead offer patients “active therapy” (physical therapy, acupuncture, massage therapy, cognitive behavioral therapy) and/or non-opioid medication. We have asked the OHA to clarify next steps if these therapies are ineffective for patients, we’re still waiting for an answer.
OHA is trying to walk back some of the proposal to better control their messaging. Publicly OHA says that this policy is about helping patients by offering additional treatment options. We are told it has little to do with combating the opioid abuse crisis, but there is obviously some confusion between outcomes and what leadership is saying.
This was evidenced in the Op-ed written by OHA Director Patrick Allen, published in the Wall Street Journal last month, “Oregon Opioid-Abuse Policy is the Right One”. It seems that even the OHA leadership can’t decide if this proposal is supposed to combat opiate abuse and addiction, or if it is a policy to improve the lives of people living with chronic pain.
Allen’s words have done little to allay the fears of chronic pain patients. In fact, the proposal has emboldened them. OHA stated in a meeting last week that they had received more than 400 emails and messages opposing to the changes. So far, and thanks largely to many of you reading this, our petition to Governor Brown and Director Allen has more than 440 signatures and growing!
People living with chronic pain want relief from their suffering. They want to be treated with the same dignity and respect that all patients deserve. They want to be partners in making health care decisions with their providers.
Opioid medications are the current clinical standard for treating chronic pain. New non-opioid treatments are in development, but many are years from approval.
Just today, a study was published in the Journal of Neurology showing that the non-opioid drug Lyrica (pregabalin), is not effective as a treatment for chronic pain because of a traumatic nerve injury. Lyrica (pregabalin) and Neurontin (gabapentin) are two of the drugs OHA plans to provide patients Instead of opioids.
People taking opioid pain medication understand the benefits and risks that these drugs can have on their mind and bodies. They are not addicts and resent being treated as such. The behavior of shaming people living with chronic pain simply trying to access legally prescribed medication is egregious. This stigma can lead to depression and isolation for patients, increasing the risk of suicide.
This is hardly in keeping with goals of Oregon Health Care Transformation, and because it threatens treatment access, may violate patient rights under Federal law.
Patients appreciate the concerns expressed around the use of opioid medications and having conversations around the benefit/risk of these treatments, and looking at additional and emerging ways to treat chronic pain. Perhaps one example might be to remove restrictions for some surgical back and spine procedures that can fix the source of pain. I would ask OHA to look at the efficacy of this strategy which can resolve the issue as opposed to additional treatment modalities to manage symptoms.
We are not asking for the impossible; we request the OHA align their opioid prescribing policy with the recommendations of the U.S. Centers for Disease Control and Prevention (CDC). The CDC guideline offer instructions on prescribing opioids, monitoring for potential misuse and using existing data sources to prevent abuse.
We ask that representatives from Governor Brown’s office and the OHA meet with patients and listen to their concerns, and their fears. Oregon Medicaid patients are afraid that the treatments they currently use to successfully manage their pain may soon be unavailable. The question is what will people living with chronic pain do then?
B.J. Cavnor manages the One in Four Chronic Health Collaborative, a voice for patients.