One way to solve the opioid crisis and improve chronic pain management is to change the conversation about pain and addiction.
And that means the healthcare industry must separate those two subjects and create a new dialogue about pain management, said Eric Schoomaker, M.D., Ph.D., professor and vice chair for leadership, centers and programs at the Uniformed Services University.
Schoomaker, a former Army surgeon general and an internist, said it's important to encourage clinicians to try non-medication solutions—like acupuncture, yoga and meditation—to address pain. And payers must cover these programs, because drugs can’t be the only solution.
“We need to get out of the drug dialogue,” said Schoomaker, one of four panelists Friday at an Alliance for Health Policy event on chronic care management. He was joined by Ben Miller, psychiatrist and chief policy officer for Well Being Trust; William Morris, M.D., a palliative care specialist at Sutter Health’s Palo Alto Health Foundation in Santa Cruz, California; and Andrea Gelzer, M.D., senior vice president and chief corporate medical officer for AmeriHealth Caritas.
Morris said his organization educates doctors on “opioid failure,” so they weed out which patients do not truly benefit from using opioid prescriptions as a long-term solution for pain.
The doctors make three considerations when defining cases of opioid failure, Morris said:
- Does the patient suffer serious adverse effects from opioids?
- Does the patient show signs of significant “aberrant behaviors” (such as drug abuse and illegal activities or medication hoarding and frequent visits to the emergency room) due to his or her use of opioids?
- Does long-term opioid therapy achieve the treatment goals?
Palo Alto Health Foundation surveyed 53 pain patients who took opioids and found that only eight (12.7%) were not considered “failures.”
Payers, too, especially those with large Medicaid populations, need to take a multifaceted approach to pain management that includes integrated care and specialized programs, Gelzer said.
AmeriHealth Caritas has taken several steps to integrate pain management into its plans, she said, including:
- Provide pharmacy guidelines for opioid prescriptions, based on the Centers for Disease Control and Prevention’s guidelines.
- Monitor physician prescribing, and call out those who are prescribing large amounts of opioids.
- Educate providers on the risks of opioids.
- Merge physical treatments, and addiction and mental health services in some of its plans.
The insurer also covers some of the more experimental pain management programs that are not traditionally in Medicaid’s fee schedule, such as chiropractic care and acupuncture.
Some members who may not be interested in recovery are more difficult to reach, Gelzer said, but the insurer tries to help them through coaching programs and community health outreach.
Providers must also make efforts to reach out to these patients, Miller said. Some take more novel approaches to outreach, but no matter the method used, the message needs to destigmatize addiction so it can truly be effective, he said.
“Let them know there is hope,” Miller said.