Hurting Pain Patients Is Not the Way to Solve the Opioid Crisis
“The insurance industry appears to have played a major role in the development of a new strategy by the federal government to combat the abuse of opioid pain medication,” writes Pat Anson, editor of Pain News Network. This Orwellian act by powerful insurance companies in collaboration with the US Department of Health and Human Services (HHS) proposes to deputize pharmacists “to report suspicious activity by doctors who prescribe opioids to Medicare and Medicaid patients (see ‘Medicare Takes ‘Big Brother’ Approach to Opioid Abuse’). Individual profiles of patients, their behavior, and opioid use would also be created and shared among insurance providers.”
Healthcare Fraud Prevention Partnership Creates White Paper
The Healthcare Fraud Prevention Partnership (HFPP) laid the groundwork for this plan by creating a “white paper” called “Healthcare Payer Strategies to Reduce the Harms of Opioids.” According to its website, “The Healthcare Fraud Prevention Partnership (HFPP) is a voluntary public-private partnership between the federal government, state agencies, law enforcement, private health insurance plans, and healthcare anti-fraud associations. The HFPP aims to foster a proactive approach to detect and prevent healthcare fraud through data and information sharing.”
According to Anson, “The white paper was drafted largely by insurance companies – called ‘Partner Champions’ – including Aetna, Anthem, Blue Cross Blue Shield, Cigna, Highmark, Humana, Kaiser Permanente and the Centene Corporation.” He further explains that the white paper “goes far beyond fraud prevention by recommending policies that will determine how a patient is treated by their doctor, including what medications should be prescribed. It states that all physicians should follow the opioid prescribing guidelines released by the Centers for Disease Control and Prevention, even though the guidelines are voluntary and explicitly state they are not intended for all prescribers.” Furthermore, the CDC guidelines are based on very limited science.
Insurance Companies Set Reduced Targets for Opioid Prescribing
Most of the major private insurance companies have set reduced prescribing targets for opioids. For example, “Cigna aims to reduce the number of opioid prescriptions written to its customers by 25%, back to the number of prescriptions that were being written in 2006, which the insurer calls “pre-crisis.”
Most people agree there are far more opioids prescribed than necessary and this has contributed to the opioid crisis. However, the problem is less about the amount of opioids prescribed than how they have been used. Setting an arbitrary goal of opioid prescribing reduction without ensuring those who need the medication continue to receive it at appropriate doses can have serious harmful consequences.
Insurance Must Mandate Coverage for Alternative Pain Therapies
HFPP is using the CDC opioid prescribing guidelines as a way to limit coverage for opioids, but without providing coverage for the alternative therapies that are also part of the CDC recommendation. If the guidelines are mandated by insurance companies, it would seem that insurance should also mandate coverage for alternative therapies.
Asking pharmacists to determine the appropriate opioid prescribing to patients will likely lead to an adversarial relationship between prescribing providers and pharmacists. This will compromise medical care for patients, not strengthen it. Should pharmacists also report when patients are denied access to appropriate opioid medications? Why not?
It is understandable that industry and policymakers want to curb the opioid problem. However, there must be compassion to improve the care of all patients, including those with pain.
Prescribing providers and pharmacists must have a collaborative relationship for the benefit of all patients. We need to allow compassion to lead us forward but allow science to light the way™.
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Copyright 2017, Lynn Webster, MD
I’m a 35 year old pain sufferer, for 23 years I’ve been on combination opioid therapy for severe, incurable disease that has taken so much from me . My medications were abruptly stopped when my pain providers license was suspended. I’m in so much pain everyday I can’t get out of my bed shower or eat. I’d wish this on no one.
Allowing big business to further dictate my care is unacceptable. The so called doctors are allowing their business to be overtaken by government and big business. The patient no longer matters. Obviously I don’t matter. My disease doesn’t matter my pain doesn’t matter I’m just a line item to these companies another complaining face to my so called care providers. I’m fed up and hurting and those very inexpensive pills each month prevented this misery from being unlivable, but now because of addicts government big business and anti science doctors, im condemned to suffer needlesly.
How are you? I hope you got some help!
I do wish this kind of pain on people, the Government, and all the doctors who won’t even fight the Government for those of us who require pain meds just to be comfortable enough to live a boring life and to work a simple job.
What they’re doing is not a solution for drug addicts or morons overdosing. I hope every single one of them feel what we feel.
I work for a non profit association whose primary goal is research and advocacy for people with Chronic Pain Disease. I will decline to state the agency on here. I would like to let any one who is reading this to know, it is NOT because of addicts that we have these problems. In the research and advocacy that do on a daily basis we have come to find out that it has very little or anything to do with the number of :addicts” and more to do with the way opioid deaths are reported and money. Those are the two biggest things. Until we, meaning society, Dr’s, government, lawyers judges and even family and friends peel back the layers of the “opioid epidemic” accurately and begin to treat Chronic Pain Disease as a DISEASE and not as a character flaw or a moral failure I fear this problem wlll continue to get worse and worse. There is hope. We are currently working on a national program to collect ACCURATE quantifiable data. In turn it is our hope, goal and dream to make this world a better place for people with a Chronic Pain Disease, whether they are a so called “addict” or not
I would like to be involved in the solution.
I have an inherited autoimmune disease where I am in pain 24/7. I take Vicodin and it takes the edge off for a few hours but then it comes back. Without the pain meds I could not have survived this long. My quality of life is poor, at best. My marriage and relationships have suffered because I cannot keep up with everyday chores and responsibilities. I feel like I am a failure, but I am not! It is the disease and not me, anyone who knew me before I became sick knows how active I was. Why would anyone choose this? Sometimes it’s the way the doctors make you feel…
Please work this I am in chronic pain and the regulations are causing me to want to stop living I cannot take NSAIDS due to kidney cancer and ha ving had partial kidney removal my life will end without pain relief
If I didn’t take opioids, I would likely commit suicide since my pain is so severe – was born with spondylolisthesis, had many back surgeries and now systemic OA, stenosis, DVD, arachnoiditis, etc. If I didn’t take opioids I would not be able to live on my own as I do now would be in a government supported home program and be a bigger EXPENSE/burden to society. Tighter controls on opioids will cause the black market purchases to go up or suicides will go up.