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The huge number of victims of the opioid epidemic has implications for policymakers at all levels of government. Unfortunately, the same sense of crisis that can help stimulate action has also led to bad policy proposals that threaten to do more harm than good.
Oregon has made a very strong decision in this regard by launching an initiative that, if passed, would require people participating in the state's Medicaid plan to "reduce" all opioid-based treatments by 2021 .
The movement has had an understandable backlash from people with chronic pain who recognize their responsible use of medicines to make their conditions bearable. Many fear that closing access to legal and prescribed opioids simply pushes individuals towards more dangerous alternatives. Yet, states in the country are already turning to Oregon's harsh measures as a potential action model.
It could be a calamity. If we really want to limit the irresponsible use of opioids while preserving their availability for the people who need it the most, it's time to move from prescription to prescription.
The Center for Disease Control (CDC) has issued new medical guidelines (PDF) for prescribing and monitoring responsible for the use of opioids in patients. More specific and comprehensive than the recommendations of previous years, the new CDC guidelines lowered the threshold of dosing (PDF) to which providers were advised to exercise caution, made specific recommendations to balance the risks and benefits monitor all patients for tolerance or opioid dependence, not just those deemed "high risk".
RELATED: AARP: 3 in 4 seniors support opioid prescribing limitations
The guidelines are firm but sensible. They emphasize patient education, refer to previously "alternative" treatment measures as a first-line remedy for physicians in the treatment of pain, and admit that there are indeed cases where opioids are an optimal solution for the treatment of pain. short-term pain management.
So why is the country still facing epidemic proportions of opioid dependence and death?
In simple terms, most doctors do not adhere to these guidelines because the entire system does not provide the right incentives. The national opioid epidemic did not occur in a vacuum. This began with the devaluation of primary care and was exacerbated by the many misaligned interests in the health sector. Today, primary health care in volume-based health systems is no more than a simple reference to unnecessary procedures, painful surgeries, and rapid prescriptions like opioids that quickly drive patients to costs of them on the fast track to addiction.
RELATED: Mayo Clinic Study: The Prescription of Opioids Flat Over Recent Years
The good news is that according to CDC guidelines, prescribers have no problem with opioid dependence, according to Mike Vasquez, who had previously founded a rehabilitation center and founded a clinical opioid management company. We can take a big step forward in resolving this crisis by transforming the CDC guidelines into requirements and applying them using the eligibility of the state health system as leverage.
If physicians are unable to participate in government insurance contracts and the corresponding federal reimbursement programs, unless they are in compliance with CDC guidelines, we may see two positive changes in the scale of the industry. Clearly, physicians could be expected to be more cautious when prescribing, continuing and increasing doses of dangerous opioids to their patients. However, an even greater transformation could also occur in the way we design and implement federal incentive payments and procedural and fee-based reimbursement models.
States can also help doctors by providing better information. Recently, a team of researchers led by experts at the University of Southern California noted that opioid prescribing rates dropped significantly when doctors were informed that their patients had died of an opioid overdose.
RELATED: A policy was aimed at curbing the prescription of opioids. Instead, researchers say that prescriptions after surgery have increased
Although the vast majority of physicians have no financial incentive to bring their patients to opioid use, they also receive few signals that they need to re-evaluate the way they prescribe these drugs. This can change when we encourage insurers to cover evidence-based non-opioid treatments as chronic pain relief, review our requirements for participation in state and federal payment programs, and inform physicians in the event of a tragedy.
Only then will we be able to turn off the faucet that is currently wasting our dollar system and flooding it with opioid prescriptions, overdoses, and deaths – once and for all, putting an end to the opioid crisis.
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