The Feds Are About to Stick It to Pain Patients in a Big Way – VICE by Maia Szalawitz
“We need to cut the supply of pain, not the supply of drugs”
Before she turned 18, Anne*, a nurse, had endured at least five major surgeries, all without the use of post-op medication stronger than ibuprofen. As a child in Birmingham, Alabama, she had been diagnosed with cerebral palsy, but eventually learned that she actually has primary generalized dystonia, a genetic disorder that causes frequent painful muscle spasms and rigidity. By 19, she says, she had tried pretty much every treatment available, including a spinal implant that made matters worse.
Then she was given a prescription opioid.
doctors and insurance companies have turned what were supposed to be voluntary guidelines issued last year by the Centers for Disease Control (CDC) into inflexible rules.
Soon, Medicare plans to follow suit, with potentially massive implications for how pain is treated—or not treated—in America.
This relentless focus on cutting medical use of opioids in the face of a real addiction crisis is starting to damage the middle- and working-class people it was intended to help. And because so many are also facing job loss and wage stagnation, we can’t really help until we recognize how economic, emotional, and physical pain are intertwined
In Anne’s case, opioids seemed like a godsend.
Thanks to this class of drugs, she says, she was able to complete nursing school and become a hospice nurse. And even when her disease progressed and she could no longer work, opioids allowed her to live independently. When she decided at one point for herself to go for months without them, Anne tells me, she lost the use of her hands
Now 36, Anne fears she will be forced to go back to that straitened way of life.
After one of Anne’s doctors stopped prescribing, she says, she called more than 60 physicians before finding one willing to prescribe the medication that works for her, despite a documented medical history without signs of addiction.
But the CDC guidelines—which were supposed to be flexible and to be used by primary care doctors (not specialists)—have increasingly taken on the air of law.
To protect themselves, some pain specialists have stopped prescribing any opioids at all or cut back patient doses to fall within the guidelines, regardless of whether their current doses are helping their patients.
Worse, just this month, the Center for Medicaid and Medicare Services (CMS) announced that it will soon apply the CDC guidelines to everyone insured via Medicare, which means that patients on high doses may find themselves cut off without much—or any—notice
Doses outside the guidelines—except in end-of-life care—could soon trigger a process that prevents pharmacists from filling prescriptions.
The Medicare plan seems to be based, at least in part, on a white paper written in collaboration between insurance companies and academic researchers. And according to Kertesz, insurers often extend policies that originate in Medicaid and Medicare to their private patients
“It’s like a runaway freight train,” says Pat Anson, a journalist who covers these issues for a specialist publication, the Pain News Network.
Indeed, in every other area of medicine, “personalization” and “individualized care” are the buzzwords—but not when it comes to opioids.
Meanwhile, the crackdown isn’t curing people with addiction, even if it does seem to be shifting them to heroin.
The result, among other things, has been more death: Just this past week, in fact, the CDC released data showing yet another jump in the overdose death rate, even though prescribing has continually fallen since 2012.
According to the study, the proportion of overdose deaths involving heroin has tripled since 2010, while those involving prescription opioids have fallen.
When yet another doctor recently stopped prescribing and she was forced to lower her dose to near the CDC-recommended levels, Anne fell out of her wheelchair and broke two crowns she’d just had placed on her teeth.
The Medicare changes are open for public comment until March 3 at this email address: AdvanceNotice2018@cms.hhs.gov
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