Despite evidence demonstrating that opioid-based prescriptions are no more effective in controlling pain than their non-opioid counterparts, doctors are protesting a new federal Medicare rule currently under consideration that would allow pharmacists to limit patient access to such medications.
The new proposal, which if adopted would go into effect in 2019, would affect opioid prescriptions made to patients under Medicare Part D. Under the new rule, a pharmacy could refuse payment on a prescription that exceeded a cumulative daily dose of 90 milligrams of morphine and notify the prescribing physician. Patients who suffer from certain conditions, such as cancer or a terminal illness could still get the prescription, but only after filing an appeal and getting a certification from their doctor.
At the same time, research carried out jointly by the Veteran's Administration Health Care System and the University of Minnesota indicates that over the long term, opioid-based analgesics are no more effective than non-opioid pain medications. In fact, they may not even work as well.
The study involved 240 patients who suffered from chronic pain of the back, knee or hip due to osteoarthritis. It was not a double-blind study; all participants were aware of what they were receiving in order to account for the psychological effects, which can have an influence on patient's sense of well-being. Dr. Erin Krebs, lead author of the study, said that from the beginning, all study participants assumed the opioids would be more effective in controlling their pain. However, after approximately 9 months, those in the non-opioid group reported slightly more relief than their counterparts who were given the opioid medications.
Krebs says that by the end, “There was really no difference between the groups in terms of pain interference with activities...over time, the non-opioid group had less pain intensity and the opioid group had more side effects.” Although the study did not discover the reason for the discrepancy, Krebs theorizes that it is a matter of tolerance. “Within a few weeks or months of taking an opioid on a daily basis, your body gets used to that level of opioid, and you need more and more to get the same level of effect,” she noted.
The study further confirms a growing body of evidence showing that opioids are no more effective than non-opioids – and the benefits of opioids are outweighed by the dangers of addiction and other side effects.
The new rule being proposed by the Centers for Medicare and Medicaid Services (CMS) would encourage participants in prescription plans to take more meaning action in addressing today's near-crisis levels of opioid addiction and abuse. Nonetheless, a letter signed by over 150 pain management specialists claim such a policy would do more harm than good – and would not go far toward solving the nation's opioid addiction problems.
Leo Beletsky, a professor of law and health sciences at Northeastern University, calls the CMS policy “a knee-jerk response that is unmoored from evidence.” He adds, “There is little reason to believe these policies will drive down overdose risk...they have never been tested with that metric in mind. There are, however, highly foreseeable collateral risks from these policies, including continuing the process of forcing patients to the black market.”