How has the change in the classification of opioid derivatives affected you?
How is your relationship with your provider, your pharmacists and others?
Dr. Terri Lewis is conducting an online survey that readers of the National Pain Report are asked to take. She wants to account for the experience of individual chronic pain patients.
Dr. Lewis, who has been a contributor to the National Pain Report, is a mother and a daughter of chronic pain sufferers, and has been looking at how the health care system is currently constructed, and importantly how it can be changed.
Just this month, she spoke at an International Pain Conference in Chicago where she argued that pain patients and providers need to better work together. (Here’s our story on her talk)
Here’s how she explains it:
“Three issues have become prominent in the national discussion about access to appropriate pain management for the more than 100 million persons who need specialized supports. Health care providers, consumers, and advocates are all struggling to adopt reasonable policy in response to the impact of changes imposed by the rescheduling of certain drugs into Schedule II.
First, in the current climate of insurance regulation, patients have little choice over their selection of pain care provider, particularly if they are in rural areas or if access conditions are imposed by payer sources. The actions of an unscrupulous provider can have significant negative impact on both quality of care and future access to care if or when the prescriber is tagged as abusing processes by regulators. Recent roundups in a number of states have resulted in dumping of patients with legitimate needs, leaving them vulnerable and without alternatives. The impact of this process on individuals remains largely undocumented, undetermined, and below the radar screen of health care providers.
Second, the rescheduling action undertaken by the DEA and FDA in response to the rise in deaths reported as opioid associated has had significant impact on patients who may receive under treatment (less than what is needed) or over treatment (over selection into costly tests and surgical installations) depending on the orientation of the only available provider. Both increase the risk of medical harm to patients and exposure to secondary injuries adding complexity and additional cost to care, along with increased disability.
Third, patients rely on secondary community systems - pharmacy access, emergency room visits, which results in the accrual of increased latent costs. Transportation costs, lost care provider work days, and pharmacy rationing (the pharmacy crawl) have deleterious effects not only on conformance and adherence to medication protocols, but also increase stress on fragile resources and reduce the working alliance so necessary to assure intended outcomes. Many report this has significantly impaired their provider relationships and resulted in them being marginalized by their health care system because of their diagnosis.
The comment period for the draft document issued by the National Pain Strategy working group has closed. But the experience of individual patients must still be accounted for. Hearing about the direct impact on patients and the difference this schedule change has imposed on their personal care support remains critical and will help to interpret and refine future approaches. Sorting out reality from myth remains an important aspect of the work of patient advocates.”
Editor’s Note: Dr. Lewis will share her findings and analysis with the National Pain Report once she collects enough data. We urge you to help her develop a data set.