The opioid abuse epidemic continues to generate state laws aimed at reducing opioid misuse and overdose. Earlier this month, New York’s Governor Andrew Cuomo signed into law a bill that restricts initial opioid prescriptions to seven days’ worth of pills. Massachusetts has enacted a similar law. But do these and similar measures succeed at curbing abuse? And do they inadvertently punish patients who legitimately need to manage pain?
Consider prescription drug monitoring programs, meant to reduce doctor shopping. New data offer a mixed view on how well such measures work. A Health Affairs study found that prescription drug monitoring programs correlate to a 1.12 reduction in opioid overdose deaths per 100,000 people. Yet a New England Journal of Medicine study surveyed prescription drug monitoring programs, along with seven other controlled substance laws, and found no link between the laws and opioid-related events.
One connection, however, does seem clear: the effect of opioid regulations on patients with pain. As The Boston Globe recently described, “In an atmosphere of heightened concern about opioids, patients in pain face reluctant doctors, wary pharmacists, and the frequent demand to prove that they are not addicts.”
Stigma and untreated pain, it seems, are emerging as the unintended side effects of some anti-abuse policies. In November 2015 an MIT researcher reviewed medical claims data for 7 million patients and discovered that, when opioid prescribing decreased, overdose deaths did decline – yet medical costs and missed work days spiked for patients with chronic pain.
That may be in part because options beyond opioid-only treatment carry limited or nonexistent health plan coverage. Balanced pain management offers patients alternate and complementary options, such as behavioral therapy, chiropractic treatment and physical therapy. But as a recent New York Times article noted, state Medicaid plans and some private insurers will not cover the cost of comprehensive treatment. Generic opioids remain one of insurers’ cheapest options for patients in pain, as reflected in some health plan designs.
Several states are awakening to more comprehensive options. Vermont recently enacted a Medicaid pilot program to test the effects of acupuncture for chronic pain, while Oregon’s Medicaid program will now offer cognitive behavioral therapy, acupuncture, chiropractic care and osteopathic manipulation. Meanwhile, the Department of Health and Human Services’ National Pain Strategy encourages exploring the merits of comprehensive approaches on a national level.
Advocates and patients often remind policymakers that 100 million Americans live with chronic pain. As more states move to address the opioid abuse crisis, their policies must also leave room for these patients to receive the balanced, physician-led care they need.