The Health Evidence Review Commission has revised its guidelines for weaning patients off the long-term use of narcotics to treat back pain on the Oregon Health Plan, delaying the stop-date by a year but requiring a more comprehensive treatment plan for pain management without the use of opiates.
The revision affects Medicaid patients who have been on long-term opiate treatment plans -- plans that will no longer be allowed for new patients.
In March 2015, the HERC, which sets the standards and determines what’s covered for the state Medicaid plan based on an evidence-based analysis, decided on Thursday to get all Medicaid members off long-term narcotic use by the end of 2016.
A bulletin noted that the coordinated care organizations’ representatives felt the deadline was coming too fast, and the revised plan veers away from a one-size-fits-all approach. The Value-Based Benefits Subcommittee recommended that the rules be changed to instruct providers to put an alternative treatment plan in place by the end of this year with a goal to get all patients off long-term use of prescription narcotics by the end of 2017.
This “taper plan” will be re-evaluated every three months as the patient’s condition changes.
Some long-term patients, however, have become hooked on opiates for pain and will now need to be treated for that dependency. One goal of the taper plan was to bring them down slowly so patients are less likely to turn to street drugs like heroin.
The guidelines approved last year for new patients remain virtually unchanged -- narcotic prescriptions may last only seven days, and to get opiates for pain longer than a week, patients will have to meet stringent requirements, to be further ratcheted down after six weeks.
Patients with back pain or recovering from surgery after six weeks will have to be referred for spinal manipulation, physical therapy, acupuncture or yoga to continue opiate treatment. After 90 days, only rare exceptions will be made for continued opiate treatment.
Congress Neuters DEA
Nationally, Democrats and Republicans in Congress alike have largely taken the opposite tack -- talking openly about improving access to drug treatment but doing little to get at the source of the problem while actually weakening federal agencies’ ability to fight the epidemic.
Congress has yet to agree on legislation that will tackle the national opioid abuse crisis, but on a quiet, unanimous voice vote, they rushed through the “Ensuring Patient Access and Effective Drug Enforcement Act,” which curtails the authority of the Drug Enforcement Administration to pursue suspicious drug distributors. The bill was championed by lobbyists from chain pharmacies and pharmaceutical distribution companies.
Dr. Andrew Kolodny, an addictions specialist and the director of Physicians for Responsible Opioid Prescribing, told The New York Times that the bill stops the DEA from “taking on corporate drug dealers in the midst of the worst addiction epidemic in U.S. history.”
