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.”
