Proposed legislation calls for partnership to help end abuse
Some are older adults with arthritis or nagging back issues. Others are younger, in agony after a sports injury. Chronic pain doesn’t discriminate; patients come from all age groups, races and income levels. Many were treated with opioid pain relievers, a practice that health care professionals and policy makers alike acknowledge has helped to fuel one of the most serious public health issues of modern times: opioid addiction and overdose-related deaths.
Reversing an epidemic
“It is no secret that opioid-related addictions and opioid overdose-related deaths in United States have reached an epidemic level,” says Buvanendran, who is a professor of anesthesiology at Rush, the vice chairman of the American Society of Anesthesiologists’ Committee on Pain Medicine and president-elect of American Society of Regional Anesthesia and Pain Medicine. “There are safe, effective alternatives that can not only provide better outcomes for patients, but also help to reverse the opioid epidemic.”
Buvanendran and other Rush physicians and researchers have been on the leading edge of an effort to find non-opioid treatments for chronic pain patients. According to the American Academy of Pain Medicine, an estimated 76 million Americans suffer from chronic pain, more than diabetes, heart disease and cancer combined. While significant, that number is not growing, although opioid prescriptions — and overdose-related deaths — have tripled since 1991. Heroin overdoses nearly doubled between 2011 and 2013; four out of five heroin users begin by misusing painkillers.
Rush’s commitment to finding alternative treatments and stemming the tide of opioid addiction has put the Medical Center in a national spotlight. Joined by Buvanendran and Gail Basch, MD, director of the Addiction Medicine Program in the Rush Department of Psychiatry, U.S. Sen. Dick Durbin last week chose Rush as the location to unveil new legislation that calls for a wide-ranging partnership to end opioid abuse. Also in attendance were Tariq Butt, MD, of the Chicago Medical Society; advocates for addiction awareness and education; and a recovering opioid user.
The Addiction Prevention and Responsible Opioid Practices Act (A-PROP) requires physicians, pharmacists, legislators, pharmaceutical companies and organizations like the Food and Drug Administration and the Centers for Disease Control and Prevention to work together to find a solution to the problem, Durbin says.
“In 2014, health care providers in the United States wrote 245 million prescriptions for painkillers, enough for every adult American to have a month’s supply of pills. Enhanced oversight and new tools are needed to shut off the spigot that is fueling this crisis,” Durbin says.
“We’re not trying to dictate the way that physicians practice,” he added. “This is a nationwide problem, and we want everyone to take responsibility for finding a solution and saving lives.”
Treating chronic pain without opioids
Buvanendran was part of a group of 18 medical professionals and policy makers across the country tapped by the CDC to create guidelines on the use of opioids and alternative treatments for chronic pain patients.
Both the guidelines, released in March, and Durbin’s proposed bill, stress the critical need to do the following:
- Make prescribing physicians and medical students aware of opioid alternatives. Buvanendran says that the CDC guidelines should list specific examples of medications that are not opioid-based and non-pharmacological approaches — such as interventional pain procedures — so that prescribing primary care physicians better understand the range of alternatives.
“It is vital that providers only consider adding opioid therapy if expected benefits for both pain and function outweigh risks to the patient,” Buvanendran says. “Understanding that there are alternatives to opioids greatly informs that consideration.”
Clearly convey the safety and effectiveness of the alternatives. “Non-opioid alternatives are not only effective, they are proven to be safe,” Buvanendran says. The Rush Pain Center has been a national leader in developing and proving the safety and effectiveness of non-opioid alternatives such as epidural injections, radiofrequency denervation and spinal cord stimulation.
Require the use of prescription drug monitoring programs. For patients on opioid therapy for chronic pain, it is critical that the health care providers review the prescription-monitoring programs when prescribing these potent drugs. Illinois is among the 49 other states to have an electronic prescription-monitoring program. This program needs to be strengthened by partnerships across state boundaries.
Require insurance companies to cover alternatives. A fundamental barrier to many physicians utilizing non-opioid pain treatments is the fact that insurance companies often will not cover these procedures. In addition, according to Basch, the paperwork required to deviate from opioid therapy is cumbersome. Opioids are relatively inexpensive and insurance protocols often dictate that the lowest cost therapy be prescribed.
- Expand treatment for addiction and increase access to drug prevention programs. A fundamental barrier to addiction treatment is the complexity involved in obtaining medications and counseling proven helpful and effective for opioid use disorder. Basch says Sen. Durbin’s proposed legislation expands treatment and increases access to drug prevention programs proven to save lives.
“Opioid addiction is widespread and is crippling our nation. It spares no race, no neighborhood, no income level,” Basch says. “We need to change the way we’re responding to what is a very treatable disease.”