To curb opioid addiction, give physicians and patients more choices for pain

President Obama’s $1.1 billion proposal for treating opioid addiction is good news for families across the country who are impacted by drug abuse.  Unfortunately, it focuses the effort on treating the addiction after it’s already begun.  America’s opioid problem will persist until our leaders also address one of the problem’s sources: patients treated inappropriately with opioids and opioids alone following painful surgical procedures.  

A number of different medications can help treat pain during and after a surgical procedure: nerve blocks, epidurals, prescription-strength forms of anti-inflammatory drugs such as ibuprofen, IV forms of acetaminophen, antidepressants, anticonvulsants, steroids, and, yes, opioids.  In an ideal world, healthcare providers could choose the best medication or combination of medications for each patient based on his or her medical history, health and anticipated level of pain.

{mosads}Unfortunately, in some clinical settings, healthcare providers have few options.  Health insurance reimbursement drives hospitals to manage patients’ pain at the lowest possible cost.  So at some hospitals, the list of approved drugs doesn’t include all viable pain medications.  

Nearly all hospitals, however, have on their approved drug lists generic, low-cost opioids.  While opioid-only pain management certainly can work, these medications can result in troubling side effects such as constipation, urinary retention, confusion, itchiness and drowsiness. They can also trigger life-threatening side effects, including respiratory depression leading to death.  These side effects are predictable and dose-related, and are particularly dangerous in elderly, frail, pediatric and obese patients.  

Opioid-only pain treatment can also introduce patients to a pain medication to which they, or a family member or friend, ultimately becomes addicted.

A similar story plays out for patients with chronic pain, such as persistent low back pain or pain resulting from an injury that never properly healed.  Statistics show that one in five Americans suffer from chronic pain.  And while an appropriate mix of different types of medications can alleviate pain and suffering, too often opioids are used as solo agents due to their cost, accessibility and familiarity.  

Treating the whole patient means addressing pain comprehensively.  But more treatments can mean higher upfront costs, despite long-term savings and improved health for the patient.  Insurance companies have designed health plans to guide patients to the least expensive options. Hospital pharmacies are under tremendous pressure to cut short-term costs without considering a treatment approach’s value for the overall health care system. And these market pressures can undermine physicians’ ability to safely and compassionately guide patient care.  As a result, patients may find themselves with a prescription opioid to manage their pain, regardless of whether it is the most appropriate course of treatment.

Obama has said he wants to help people who are battling prescription drug and heroin abuse.  Leaders and members of both political parties feel the same.  But in addition to treating those who are addicted, let’s take this problem to its source.  Policymakers must empower physicians to treat pain comprehensively, precisely and on a patient-by-patient basis.  That requires health care providers, not insurance policies, to determine which treatments are available to patients in pain.

Soto is a board-certified anesthesiologist practicing in Royal Oak, Michigan, and a member of the Alliance for Patient Access.


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