Just days before the new year, the Centers for Disease Control and Prevention announced that over 1 million Americans died over the past two decades due to America’s other public health crisis: the opioid overdose epidemic. While the federal government has reacted swiftly and aggressively to address COVID, its response has not nearly been as expeditious with regard to opioids.
As with past opioid crises in American history—see the post-Civil War heroin epidemic—this one was caused by an over-reliance on prescription painkillers. Since pharmaceutical companies began aggressively marketing powerful new opioid-based painkillers in the 1990s, opioids have become abundant. While opioids are an appropriate course of treatment for certain patients in certain situations, they are not the grand solution to every patient’s unique health problems. They have become an easy way for doctors to address pain issues. The healthcare system has too long brushed aside a wide variety of non-opioid pain management approaches that are both safe and effective.
The current crisis did not begin in a vacuum. While the public’s attention has rightfully focused on the alarming role of fentanyl, a powerful synthetic opioid that is highly profitable for drug cartels, overprescription can’t be overlooked. Between 1999 and 2019, overdose deaths from prescription opioids took the lives of 247,000 people. Meanwhile, prescription opioids represent a major pathway for illicit street drugs that can be even more deadly. According to the National Institute on Drug Abuse, “the incidence of heroin initiation was 19 times higher among those who reported prior nonmedical pain reliever use than among those who did not” and “a study of young, urban injection drug users interviewed in 2008 and 2009 found that 86% had used opioid pain relievers nonmedically prior to using heroin.”
These hard drug users started down that life-destroying path by first using (or misusing) prescription opioids. That is because they are widely available. According to one study published by The Journal of Pain, the average patient undergoing surgery receives 80 opioid-based pills after their operation, yet leaves an average of 30 pills unused. This suggests that too many patients receive too many pills, driving the risk of diversion and abuse.
Despite progress in preventing overprescription, more must be done to ensure that patients have access to non-addictive drugs and devices to treat their pain. Currently, the Medicare system disincentivizes physicians from utilizing non-opioid-based drugs and devices to help manage seniors’ surgical pain.
Because opioids are reimbursed by Medicare separately, whereas non-opioid pain management approaches must be paid for by physicians out of the surgical package they receive, access to non-addictive treatments––such as long-acting local anesthetics, non-steroidal anti-inflammatory drugs (NSAIDs), and devices that target the nervous system—is limited. Medicare’s payment policy has made it more difficult for physicians to utilize everything from nerve blocks to ophthalmologic solutions that reduce pain scores and fentanyl use. Though seniors may not immediately spring to mind when one thinks about opioid overdose, the Department of Health and Human Services (HHS) found that 43,000 Part D beneficiaries suffered an opioid overdose in 2020.
To ensure that a wide variety of drugs and devices can be utilized as appropriate, it is necessary for Congress to level the playing field by passing the Non-Opioids Prevent Addiction in the Nation (NOPAIN) Act (H.R. 3259/S. 586). The legislation, which enjoys widespread bipartisan support in the House and Senate, would direct Medicare to treat opioid- and non-opioid-based pain management approaches on the same footing under its reimbursement policy for all outpatient surgical procedures.
The NOPAIN Act would not prevent doctors from prescribing opioids when they are medically necessary, nor would it incentivize the use of non-opioids over opioid-based painkillers. The legislation’s technical fix would have a major impact on seniors, including the 1 in 4 Part D beneficiaries who receive opioids―whether or not other approaches might be safer or more effective at meeting their unique medical needs.
In an era of hyper-partisan gridlock, the NOPAIN Act represents a rare point of agreement. To date, 84 House and 41 Senate sponsors from both sides of the aisle have joined together to help address Medicare’s role in the overprescription of opioids. With virtually every community in the U.S. feeling the pain and impact of opioid overdose deaths, it seems that Congress has found one issue that they can pass this year with little push back from the partisans in both parties.
Brian Darling is former counsel and senior communications director for Sen. Rand Paul of Kentucky.