If you’re a patient who’s had a surgery and dealing with acute post-surgical pain, why choose an opioid-based pain reliever when there are equally effective, FDA-approved, opioid-free alternatives? That’s the question medical professionals, addiction specialists, youth advocates, and others are asking.
Unfortunately, due to a flaw in the way parts of the health care system are paid for, particularly in Medicare: Patients and providers are steered towards using opioids.
It’s disappointing to realize that something as simple as outdated Medicare reimbursement rules can push narcotics on patients. The hard reality is these rules, which effectively incentivize the use of opioids for post-surgical pain relief, are contributing to the deadly oversupply of opioids in our communities.
In 2016 alone, more than 340 Alabamians died of opioid overdose. This is a crisis impacting all facets of society – patient, providers, families, students, and businesses alike. However, there is reason for hope in that many affected families are not letting despair undermine their resolve to combat the problem, using every means possible. That’s the impetus behind The Will Bright Foundation, named for Will, who died of overdose at age 25.
As important as it is to support treatment for those with existing substance abuse disorders, we also need to focus on getting ahead of this crisis. Prevention is a powerful tool to get ahead of the crisis and protect people from being exposed to potential risks early-on.
Reducing exposure to opioids in the first place is an important place for us to start. Every opioid exposure increases addiction risk. In 2015, there were over 141 opioid prescriptions written for every 100 people in Alabama—enough to give each resident a bottle of painkillers and then some.
Opioids can be medically necessary, but post-surgical prescribing could be reduced if non-opioid therapies were more widely used. Physicians and other medical professionals want to turn to these safer medications, but they face significant barriers. Medicare policy is a big one.
Surgeries are currently compensated by Medicare with a lump sum, which must cover any post-operative pain medicines. Non-narcotic painkillers cost modestly more than opioids, up to $300. At a time when hospitals, especially those in rural areas, are struggling for survival, they cannot independently absorb that cost increase for hundreds of operations each year. How Medicare reimburses makes a difference, because 44 million older and disabled Americans—15 percent of the population—rely on Medicare for their health coverage. The end result: opioids are prescribed for nine in ten surgical patients, even though many safer drugs exist.
For patients undergoing multiple procedures, repeated post-operative treatment with opioids poses serious risk. And for those with a history of addiction, a dose of codeine can be enough to spark a relapse.
It’s no wonder older people are exhibiting a sharp increase in opioid use disorders. They are not seeking a high from these drugs, but they are being repeatedly and dangerously exposed to them through routine medical treatment.
Complicating the issue, the vast majority of patients don’t finish their painkiller supply. Without proper disposal, the drugs linger in medicine cabinets, where they are accessible by family members, guests, and thieves. Literally billions of legally prescribed pain pills have found their way onto the streets.
These drugs are flooding our college campuses and our high schools. Young people report that prescription painkillers are easier to obtain than alcohol. But every “experiment” with a narcotic is hazardous. Suddenly, a good student takes a painkiller recreationally—or is treated for a legitimate medical issue after a few non-medicinal exposures—and they just can’t stop. This is far too dangerous a trap to set for people at such a vulnerable age.
Fortunately, Alabama’s U.S. Senator Doug Jones is out in front on this issue. Along with Republican Sen. Bill Cassidy of Louisiana, Senator Jones has asked the federal government to change Medicare rules to separately reimburse for non-opioid pain medicines used after surgery. This will tip the balance toward safer, non-opioid medicines and help keep opioids out of our communities.
Reduce exposure, reduce supply, and we can reduce addiction.
Katie Beckham, PA-C, MSPAS, Alabama Society of Physician Assistants
Lisa and Bill Bright, founders of the Will Bright Foundation
Gerald Fraas, president and co-founder of Students for Opioid Solutions
Dr. Paul Rider, M.D., University of South Alabama Medical Center