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Oregon may have some of the country's strictest limits on opioids for patients with chronic pain as part of a proposed proposal for the state's Medicaid program. The proposed change would limit the coverage of Oregon's health plan for five major chronic pain to 90 days of opioid analgesics and would force patients who take opioids longer to withdraw from these medications in the future. ;year.
State officials claim that this measure is aimed at reducing the over-prescription of opioids, which has led to an overdose epidemic and to providing alternative treatments until then inaccessible to members of the drug treatment regime. Oregon health.
The proposal has angered and frightened many patients with chronic pain who claim that alternative approaches do not work for everyone and that the decision to stop opioids should be made by the patient's physician and not by a government agency. "People with chronic pain are facing debilitating conditions that affect the quality of life, but we are facing this important epidemic of opioids where we know that there is a lot of abuse and over-prescription, "said Dr. Dana Hargunani, Chief Medical Officer of Health. the Oregon Health Authority. "We try to use evidence to guide us, but we really appreciate public participation in the process. I know that it is a very important problem for many people.
The proposed change comes from the Chronic Pain Working Group, an ad hoc committee created to provide advice on reducing the use of opioids as part of the Oregon Health Plan. Oregon's health plan has a unique structure among Medicaid's state programs, relying on a prioritized list of health services ranked by experts in importance. for patients. State legislators then decide where, in the list of priorities, draw the line between services covered and not covered.
Currently, the five conditions discussed – fibromyalgia, chronic pain syndrome, chronic pain due to trauma, other chronic post-procedural pain and other chronic pain – fall below the line, and therefore the treatments for these diseases are not covered. Health plan. But according to the Oregon Health Authority, many patients with these five conditions are prescribed opioids. The Oregon Health Plan has no way of knowing if these patients are being prescribed opioids for chronic pain problems or for services covered and, therefore, can not refuse to cover these. requirements.
By establishing a new entry in the priority list above the cut line, Oregon's health plan would then cover alternative treatments, such as yoga, acupuncture, or therapy. physical, but would try to limit the use of opioids.
Patients with chronic pain gathered last week in front of the OHA offices in Salem to protest the change. Organizers of the protest refused to comment on the case, citing fears of reprisals and fearing that their access to pain medication would be interrupted.
Steve Hix, a 50-year-old Albany who is almost completely bedridden with injuries to the spine and back, has suffered from a day spent in his wheelchair protesting opioid restrictions.
"We have a law so that people in this state can have death with dignity," said Hix. "Why do not we have a law so that we can have life in dignity?"
In 1990, Hix was hit by a semitruck while he was driving his motorcycle, then suffered a series of falls in 1994 that left him with spinal damage and excruciating pain. His doctor persuaded him to commit suicide and organized a spinal fusion surgery for him. He prescribed high doses of Hix opioids to cope with the pain.
For over 13 years, Hix used fentanyl patches and morphine pills to control his pain and add medical marijuana to distract his pain. When his doctor announced his intention to retire during the year, Hix was afraid of being cut off from his high doses and began to get rid of his high doses, foaming his unused medications just in case.
"The fewer medications I took, the more I ended up in bed," Hix said. "The pain I had to endure to get to the event, you could not even imagine."
Chronic pain patients plan to fight in front of a committee of the Commission's benefits committee. Health Evidence Review, which will consider the proposal at its August 9 meeting. The plenary committee could give final approval as early as October, but the restrictions would come into effect as soon as possible in 2020.
The proposed change reflects a low back pain policy implemented in 2016 with similar limits in the long term opioid prescriptions. But this policy has proven difficult to implement.
The Priority List represents the minimum level of coverage provided by the Oregon Health Plan, but care is provided primarily through regional coordinated care organizations that have no way of determining the condition prescription of opioids, unless authorized.
"It would be extremely difficult to implement (pre-authorization) criteria on a broad category of drugs," said Dr. Alison Little, medical director of Medicaid programs for PacificSource Health Plans, which manages the CCO in the center. from Oregon. "PacificSource sent letters to physicians in 2016 to inform them of the new rules of low back pain and focused on reducing patients with the highest daily doses. opioids to bring them below the guidelines established by the Centers for Disease Control and Prevention. These guidelines require that doctors not prescribe more than 90 milligrams of morphine equivalent per day, or to justify their decision to do so.
However, the CDC guidelines did not provide clear guidance on what to do with patients who were taking doses above this threshold for a longer period. Some doctors have interpreted the directive to mean that patients should be amputated below this threshold, even if they are not willing to do so.
While studies suggest that higher doses of opioids increase the risk of overdose, little research suggests that cones, especially tapered cones, improve outcomes for patients.
Little said that she heard little backsliding from patients or doctors about low back pain guidelines and that she was not sure of the number of patients who had completely decreased their opioids.
"What I do not know, is how many patients pay in cash," she said. "We can have limits on what we pay, but that does not stop them from getting more."
According to data from the drug monitoring program, the number of opioid prescriptions in central Oregon has declined significantly in 2017, although, it is unclear how much of that could be attributed to Oregon Health Plan coverage changes. The number of high dose opioid patients in the region has also been steadily decreasing since 2015.
Kim Swanson, Director of Behavioral Health at Mosaic Medical and Chair of the Pain Standards Working Group Central Oregon, said that opioids.
"They are gradually reducing themselves to the range of 50 to 90 milligrams since 2014," she said. "There are still people taking opioids, they have just been tapered into a safe dosage range."
The opioid prescription at the statewide is decreasing since 2014, while the use of alternative treatments such as acupuncture, chiropractic and the Therapy increased in 2016 and 2017 after the adoption of the new low back pain policy.
The percentage of patients with low back pain on OHP with prescription opioids decreased slightly from 34.5% in 2016 to 33.9% in 2017. The percentage of patients with high doses of opioids decreased from About 25%, and at a very high dose of 19%.
Critics say the proposed policy is flawed because overdose deaths from prescription opioids are decreasing, while deaths by heroin and other illicit drugs are increasing. Patients with chronic pain like Hix feel punished and treated as criminals, even if they have never abused their medication.
"I am very sad for the people who lost their lives," Hix said. "But what does this have to do with me?"
– Reporter: 541-633-2162, [email protected]
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