The Challenge in Accessing Non-Opioid Pain Management Approaches

Despite a historic surge in opioid overdose deaths, far too many patients are still left without the ability to choose non-opioid alternatives when it comes to acute pain management. Instead, the choice is made for them due to arcane reimbursement policies that incentivize the use of opioid medications. Congress can change this reality by passing the bipartisan NOPAIN Act, which would empower providers and patients with more choices in non-opioid pain management.

Although it may not be as prevalent in our newspaper headlines, the opioid epidemic in America has not gone away – in fact, the current pandemic has undoubtedly exacerbated the crisis. Opioid-related overdose deaths are on the rise for the first time in years. A recent analysis by the White House Office of National Drug Control Policy showed an 11.4 percent increase in drug-related fatalities in the first four months of 2020 compared to the same time period in to 2019.

While studies show addiction can begin with using and misusing substances such as alcohol, nicotine and marijuana, addiction also can begin, and often continues to be fueled, by being prescribed legal opioid pills. In fact, the vast majority (80 percent) of heroin users started by misusing prescription opioids, which are frequently prescribed in the United States. The Centers for Disease Control and Prevention  estimates that there were more than 168 million opioid prescriptions dispensed in the United States in 2018 alone.

One common source of first-time opioid exposure is the operating room, and research shows 3 million surgical patients per year become persistent opioid users, continuing to take these medications three to six months after their surgery. On average, patients receive 82 opioid pills each, which puts not only individual patients at risk of developing opioid use disorder, but also the friends and loved ones due to leftover pills being diverted throughout our communities.

One thing is clear: We must address – and prevent – opioid addiction where it starts. More can, and must, be done to reduce unnecessary levels of opioid prescribing and consumption in the United States. One simple way to accomplish this is to increase access to and utilization of non-opioid pain management approaches that can reduce or eliminate the need for opioid-based pain control.

Doing so offers many advantages. First, research shows that, if given the choice, patients prefer non-opioid approaches when it comes to managing their pain. Second, utilization of non-opioid pain management approaches offers meaningfully improved clinical outcomes, including lower patient-reported pain scoresdrastically reduced consumption of opioidsshorter hospital staysfewer opioid-related adverse events and faster recovery after surgery. Because of these benefits, patients who are treated with non-opioid pain management options save the health care system money as compared to those treated with opioids.

Unfortunately, accessing non-opioid pain management approaches is a challenge – both for patients and providers. Current Medicare policy encourages the utilization of less expensive opioids to treat pain, despite the demonstrably improved outcomes from non-opioid therapies and approaches. As a result, millions of surgical patients each year are left without a choice in how they – and their healthcare provider – manage their pain.

Legislation to address this discrepancy has been introduced in Congress. The Non-Opioids Prevent Addiction in the Nation Act or “NOPAIN Act” (S. 3067/H.R. 5172) would increase patient and provider choice and access to the wide array of non-opioid treatment options for acute pain patients and prevent millions of Americans from becoming addicted to or dependent on opioids every year.

Preventing opioid addiction requires a fundamental change in the status quo. Part of such a paradigm shift surely involves improving and facilitating increased patient and provider communication about pain management options. However, if we are serious about preventing opioid addiction, we must do more to increase the availability of non-opioid therapies and approaches. Doing so would meaningfully improve patient care in the United States, decrease the availability of excess opioid pills available for diversion in communities and substantially reduce the number of Americans who are at risk of addiction or dependence following a surgical procedure.

Chris Fox is the executive director of Voices for Non-Opioid Choices. General Arthur T. Dean is the chairman and CEO of Community Anti-Drug Coalitions of America.

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