The Opioid Epidemic Part II: Prescribing Restrictions Causing Harm to Chronic Pain Endurers

Written By Maayan Simon

The Opioid Epidemic Part II: Prescribing Restrictions Causing Harm to Chronic Pain Endurers

As covered in The Opioid Epidemic Part I the opioid crisis has wreaked havoc on countless lives through addiction and tragic loss of life. Yet chronic pain endurers who do not misuse opioids are overlooked casualties, as well. Many people who have safely used long-term opioids for chronic pain are now unjustly barred access to the medications they critically need.

In 2016 the Centers for Disease Control and Prevention published “CDC Guideline for Prescribing Opioids for Chronic Pain,” recommending opioids be limited to a maximum of 90 mg morphine equivalent units per day (Dowell 2016). In response, the Center for Medicare and Medicaid Services (CMS) drastically restricted Medicare opioid coverage (Centers for Medicare and Medicaid 2018) with many states (Smith 2019) and private insurers following suit (Hoffman and Goodnough 2019). These guidelines were not meant to be binding but misinterpretations have created an environment in which medical providers fear legal or disciplinary action if they prescribe opioids (“CDC Advises Against Misapplication” 2019).

Chronic pain patients being forced to endure unmanageable pain due to tapering of opioid medications or downright denial of prescriptions has resulted in testimony similar to that of torture survivors (Anson 2018). Negative impacts of opioid prescribing restrictions have resulted in the erosion of trust and confidence in relationships with medical providers, increased anxiety and mental health concerns over uncertainty of being able to keep pain manageable, loss of autonomy and self-determination in patient pain management, and increased stigma perceived by patients (Huang 2018). Prescribing restrictions have particularly impacted older adults, who account for 18 million chronic pain patients in the U.S. and are less likely to misuse or become addicted to opioids (Ritchie 2020). In 2019 the CDC issued a statement advising against the misapplication of the 2016 guidelines but both opioid restrictions and stigma continue (“CDC Advises Against Misapplication” 2019).

In the big picture the number of chronic pain endurers who misuse opioids is small relative to overall misuse. Approximately 21 to 29% of people prescribed opioids for chronic pain misuse them, and 8 to 12% develop an “opioid use disorder” (National Institute on Drug Abuse 2021). Estimates have put the total number of people using long-term medical opioids at 9 million, and approximately 20% of patients who are prescribed high doses of opioids make up 80% of overdoses (Blum et al. 2018).

Despite the facts, people in pain continue to be blamed for the opioid crisis, causing a self-perpetuating cycle of stigma and injustice. In a 2018 report 63% of U.S. reporters and journalists surveyed attributed chronic pain as a “major cause” of the opioid epidemic even though no evidence substantiates this conclusion (PAINS Project 2018). All the while, the true culprits, like negligent pharmacies such as CVS, Walgreens, and Walmart illegally flooding rural communities with opioids, are underreported (Kornfield and Bernstein 2021). Even worse, in Alabama a pregnant woman with severe pain was charged with the felony of prescription fraud for refilling her own opioid prescription and using it as directed, which pregnant or not, is completely legal (Kornfield 2021).

Covering preventative screening, such as tests for genetic addiction risk factors, could go a long way toward safe opioid prescribing (Blum et al. 2018). Additionally, according to a 2018 Gallup poll, 78% of Americans prefer to try drug-free options for pain (Gallup, inc. 2020). But if drug-free options are not covered by insurers, or have high out of pocket expenses, many people cannot access them. Medical providers and insurance company decision makers also frequently lack the education and understanding to support more multidisciplinary, integrative treatment, let alone make it available to patients (Heyward et al. 2018).

The impacts from prescription opioid abuse in the U.S. cost an estimated $78.5 billion annually (National Institute on Drug Abuse 2021). The amount of money invested in pain research is a pittance by comparison. Despite chronic pain affecting more people than cancer, heart disease, and diabetes combined, in 2019 the National Institutes of Health (NIH) spent 88% less on chronic pain research than for research into these conditions (Chronic Pain Research Alliance 2020). This includes $500 million specifically allocated to chronic pain research through the NIH’s 2019 HEAL initiative (“NIH funds $945 million in research” 2019). 

More and better chronic pain interventions must be developed. Additionally, funding for genetic testing for predisposition to addiction or misuse of opioids must be increased. Pressure must also continue to be put on insurers to cover integrative and multidisciplinary chronic pain treatments.

Note: I, Ma’ayan Simon, and unshamepain.com are not affiliated with any of the above organizations or agencies.

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Sources

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Blum, K, W Jacobs, E J Modestino, N DiNubile, D Baron, T McLaughlin, D Siwicki, et al. “Insurance Companies Fighting the Peer Review Empire without Any Validity: the Case for Addiction and Pain Modalities in the Face of an American Drug Epidemic.” SEJ surgery and pain. U.S. National Library of Medicine, October 4, 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5998670/.

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Centers for Medicare and Medicaid. “Medicare Program; Contract Year 2019 Policy and Technical Changes to the Medicare Advantage, Medicare Cost Plan, Medicare Fee-for-Service, the Medicare Prescription Drug Benefit Programs, and the PACE ProgramMedicare Program; Contract Year 2019 Policy and Technical Changes to the Medicare Advantage, Medicare Cost Plan, Medicare Fee-for-Service, the Medicare Prescription Drug Benefit Programs, and the PACE Program.” Federal Register, April 16, 2018. https://www.federalregister.gov/documents/2018/04/16/2018-07179/medicare-program-contract-year-2019-policy-and-technical-changes-to-the-medicare-advantage-medicare.

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Dowell, Deborah MD. “CDC Guideline for Prescribing Opioids for Chronic Pain, 2016.” JAMA. JAMA Network, April 19, 2016. https://jamanetwork.com/journals/jama/fullarticle/2503508.

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Maayan Simon
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