By Steven R. Ariens, P.D. R.Ph.
A proposed policy that would restrict Oregon chronic pain patients on Medicaid access to opioids for chronic pain as reported by the National Pain Report and others have created a stir in the chronic pain community. Columnist Steve Ariens, a retired pharmacist and spouse of a chronic pain patient submitted this opinion.
Oregon is set to eliminate all opiates from being prescribed for all chronic pain and Fibromyalgia patients on Medicaid by 2019. The Oregon Health Authority is considering expanding coverage for alternative therapies like aqua therapy, mindfulness and acupuncture.
You wonder why Oregon is making the move. Where are all the double blind clinical studies to prove that these therapies will help reduce the intensity of pain of chronic pain patients and what percent – if any – of the patients participating in the clinical trial had what level of pain relief reduction?
Just like the clinical trials that “everyone” wants to see to validate that opiates works for chronic pain long term. “Everyone” dismisses the anecdotal evidence that opiated work long term. What they don’t divulge is that most/all clinical trials that has been tried to demonstrate that opiates work long term, are stopped at 12 weeks out of fear of addiction/dependency – or that long term use is defined as more than 90 days and the clinical trials are stopped at 84 days.
“They” tend to ignore and/ or discount studies that have found that patients were found to be functioning quite well after 10 or more years on generally stable opioid dosages, with the vast majority of patients able to care for themselves, drive their cars etc.
“They” also tend to discount the reports that opiate prescriptions are down about 25% from their peak in 2011-2012. While during the same time opiate OD’s have almost DOUBLED and the typical OD has 4 to 7 different substances in their toxicology report–including illegal Fentanyl analog, Heroin and Alcohol for “starters”. Most likely those ODs are not chronic pain patients who are using the opioid therapy to improve their individual quality of life.
Then if you follow “the money trail” you find that Marijuana is legal in Oregon (Medical in 1998 and recreational in 2014) and produces a “tax revenue” for the state and not paid for by Medicaid and there are no double blind clinical trials that validate what percent of chronic painers – if any – using marijuana get their intensity of pain reduced.
Also, Oregon is one of a handful of states that has a “death with dignity” law allowing terminal patients to elect to end their life with assistance from their prescriber. When pain is not treated, bad things can happen. It can delay healing, decrease appetite, increase stress, disrupt sleep and ultimately cause anxiety and depression While these adverse physical health outcomes may make the patient eligible for using Oregon’s “death with dignity law”. Of course, if a Medicaid patient elects to go down this path, the Medicaid system stands to save untold tens of thousands of dollars in expenditures for these patients if they did not exercise for this option.
It is reported that Oregon has a $1-billion annual budget shortfall. Are these bureaucrats in Oregon be working under the false pretense that if they curtail the prescribing/dispensing of legal opiates it will cause a dramatic reduction in the demand and addiction to opiates?
Oregon is very active in dealing with businesses in the state discriminating against certain protected class of customers (wedding cake story) but the bureaucracy itself can discriminate against people/patients that are considered a protected class under the Americans with Disability Act. Does make the state seem a bit hypocritical?
Just like our Congress made our judicial system in charge of “war on drugs” in 1970 with the passage of the Controlled Substance Act and our judicial system has only “one tool” in their “tool box” to “treat” the mental health issue of addictive personalities—put them in jail—and I am not aware of any clinical study that demonstrates that jail/prison will get an addict to get/become and stay sober.
In fact, studies suggest that such “abstinence therapy” have less than 5% success rate.
Hopefully, the bureaucrats in Oregon will take note of what happened when the Governor of Kentucky recently tried to take away Medicaid’s pts dental and vision coverage. Kentucky’s attempt to cut dental and vision coverage for 460,000 Medicaid beneficiaries has now been blocked by a Federal Judge. Chronic pain patients in Oregon are organizing and making noise, despite the lack of transparency that these new guidelines have received. They are fighting the proposed guidelines because they have to.
Their lives may depend on it.
Common sense is needed in how we approach the treatment of chronic pain. The conversation needs to be about what works and then that the poorest among us get a chance to utilize it. Maybe talking with the patients and the doctors that treat them is a place to start and Oregon can develop a policy based on patient need rather than emotion.