Report urges move away from prescription drugs to treat chronic pain

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A new medical report highlights how Vermont’s health care system financially encourages a patient’s dependence on opioids, instead of other more effective and less addictive remedies.

The report, which was authored by Dr. Cyrus Jordan of the Vermont Medical Society Education and Research Foundation, draws from the interviews of roughly 30 health care professionals across a range of fields in Vermont and New Hampshire.

The “white paper” is titled the “Safe and Effective Treatment of Chronic Pain in Vermont,” and it is the first in a series about issues surrounding Vermont’s health care system. Jordan said that after nearly six months of research, every health care professional interviewed repeatedly expressed concern about how chronic pain is treated in the Green Mountain State. Vermont’s dependence on such prescription drugs is a microcosm of a larger nationwide “epidemic” identified by the Federal Drug Administration.

Jordan took the professionals’ suggestions for treating chronic pain and compiled them into a series of six key recommendations and seven areas for potential innovation. One of those six recommendations is to “discourage payment policies that encourage pill prescribing.”

“Every system is perfectly designed to produce the results it’s producing,” he said in an interview on Thursday. “Fee-for-service, the way we reimburse health care, is perfectly designed for very brief interactions writing pills — no talk, no ancillary services, no counseling.”

An unnamed primary care physician in Jordan’s report spotlighted how insurance companies exacerbate this problem.

“One very big issue is how the insurance companies are actually driving a lot of the dependence on opioids,” he said. “For example, research shows that for chronic non-specific low back pain, chiropractic manipulation, acupuncture, and massage are all helpful. Yet many insurance companies won’t cover these. But they will cover the Percocet, which has not been proven to be helpful in research.”

The report also recommends the creation of a unified set of standards for treating chronic pain in Vermont.

“Chronic pain has become the bane of primary care and many specialty practices,” reads the report, noting the need for a single set of practice recommendations to help solve the complex problem of treating pain but not promoting opiate addiction.

The report also calls for improvements in the Vermont Prescription Monitoring System. One of the paper’s overarching recommendations is to give Vermont physicians access to controlled substance data from neighboring states. The report explains that not having this information is a problem for prescribers in the Connecticut River valley, where prescriptions can easily be filled in New Hampshire unbeknownst to Vermont prescribers and pharmacists. The report also recommends that this information should be linked to other physician databases.

The other three recommendations in the paper are to launch a public education campaign to teach people about “the dangers of long-term opioid therapy,” re-evaluate the oversight methods for prescribers and better differentiate the roles of law enforcement officials and caregivers when it comes to opioid treatment.

The seven innovations recommended by the report for treating chronic pain and reducing opiate addiction are:

• Creating a pain and addiction hotline.
• Establishing hospital-based resource centers in communities across the state.
• Providing an on-call, real-time medical management service.
• Improving the use of information technology.
• Establishing a centralized urine screening system.
• Creating cost-neutral opioid treatment clinics.
• Using telemedicine methods to provide clinical advice via telecommunication mediums.

“The report highlights how complex this problem is,” said Jordan.“We need to be very thoughtful about how we move forward. On the other hand, there are some very concrete actionable things that we suggest.”

Andrew Stein

Comments

  1. Anna Carey MD :

    Thank goodness for Dr. Jordan’s report. Ever since, Oxycontin was formulated and marketed in the late 1990’s, family docs have been inundated with messages that we need to be more ‘liberal’ in our treatment of chronic pain. With no evidence based data, we were given classes on how to prescribe potent narcotics at high doses. Just like many other promotional drug hoaxes, certain pharmaceutical companies were the bandits and patients the prey. We have experience too many deaths and near-deaths from overdose in every neighborhood of Vermont and the country. Let’s reverse this unfortunate gaming of a profit hungry system and question all non evidenced based fads that are bound to follow.

    • Dave Bellini :

      Why would an MD waste time taking a class “With no evidence based data…” in the first place?

      The vast majority of Doctors are responsible but there’s always a few that are quick with the script. Mercifully some of the worst offenders have retired. Too bad the study didn’t identify which specific Doctors are writing the most Rx’s for opiate drugs. Transparency and peer review would do more than another legislative document. But, Doctors don’t like to get reviewed or evaluated and in Vermont no Doctor would ever criticize another Doctor, no matter how much of a quack they are.

  2. James Gill :

    Come-on Doc ……. The people that write the prescriptions for these drugs are people with a MD after their name. So your crowd owns as much, if not more, responsibility for this problem as the drug manufactures. So let’s have fair distribution of ‘blame’.

  3. Michele Doucette :

    I look forward, and work toward, the day when we can work more collaboratively with chronic pain patients. As a chiropractor, I see marked decrease in chronic pain with patients who have access to supportive, integrative, and wholistic hands-on care. The major insurers in VT, however, continually find ways to limit coverage for chiropractic care to acute conditions. The chiropractic profession can help decrease reliance on addictive drugs. Let’s communicate, educate, and learn to trust each other for the good of all Vermonters.

  4. Lester French :

    My insurance company considers chiropractors as specialists, with a high co-pay. A trip to a “regular” doctor with a prescription for drugs to kill the pain is likely to cost less out of pocket for a significant period of time. The focus of the insurance industry and acceptance of alternatives by the MD’s should be a priority.

  5. David Carter :

    I recently read that the US, with about 5% of the world’s population, consumes about 50% of the world’s prescription drugs. The last statistic I saw has us at about 37th globally in life expectancy. Doesn’t take a rocket scientist to figure out this isn’t working.

    So why are things the way they are? It’s all about the money. Big Pharma has absolutely no interest in products that will cure you. That would be a self defeatuing prophecy. They’re corporations, and they’re supposed to make profits, and they have a pretty good track record of doing that. Virtually every other nation on Earth sells the same drugs that we consume, but at a much lower price. Hmmm…. I’m sure it’s just a coincidence that Big Pharma has at least 1,000 lobbyists in DC. What a system – stereo influencing for just about every Congressman, not to mention that there’s plenty of contributions and perks to go along with that sound system.

    The AMA has a sordid history; it isn’t in the business of helping doctors make better decisions. Do a little research on one of the AMA’s leaders, Morris Fishbein; not exactly a stalwart of integrity. But he did implement a system of brainwashing that still exists today.

    Until we separate the political process from the corporate control, we will end up with situations like the current problems that we face. How much crime is related to the system that allows doctors to hand out narcotics like candy?
    Why don’t many insurance companies pay for pain treatments such as chiropractic and TCM? A truly sad state of affairs.

  6. rosemarie jackowski :

    In defense of those with cronic pain and the M.D.s who treat them…this report seems to be too much “big brother’. The patient-doctor relationship should be respected and it should be private.

    Of course addiction can be a problem, but but let’s not paint all patients with the same brush.

    I bet those who wrote the report were never seriously injured when rear-ended by a large speeding dump truck.

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