In mid-July, a group of patients with chronic pain, advocates and family members picketed to protest a proposal by the Oregon Health Authority to severely limit patients’ access to opioids through the Oregon Health Plan. The issue has received considerable media attention in Portland. One of the group’s organizers says lack of transparency by state health officials has made it difficult to track exactly how the new guidelines are being developed.
The Oregon Health Evidence Review Commission (HERC) and its subcommittee Value-based Benefits Subcommittee (VbBS) will submit their proposed changes to Medicaid to discontinue long term opioids for chronic pain and fibromyalgia. The changes include a forced taper for all chronic pain patients within a year with no exceptions. Opioids will be replaced with alternative treatments including cognitive behavioral therapy (CBT), acupuncture, mindfulness, pain acceptance, aqua therapy, chiropractic adjustments, and treatment with non-opioid medications.
The National Pain Report published an article by columnist Steve Ariens, a retired pharmacist and spouse of a chronic pain patient. Ariens argues there is not enough data proving the effectiveness of alternative therapy, but there is significant data proving the effectiveness of opioid use for chronic pain.
Ariens believes that health officials supporting the proposed changes “ignore and/or discount studies that have found that patients were found to be functioning quite well after 10 or more years on generally stable opioid dosages, with the vast majority of patients able to care for themselves, drive their cars, etc.” He also points out that opiate prescriptions are down about 25 percent from their peak in 2011-2012.
Ariens notes Oregon’s $1 billion dollar annual budget shortfall when he warns, “Oregon is one of a handful of states that has a ‘death with dignity’ law allowing terminal patients to elect to end their lives with assistance from their prescriber. When pain is not treated, it can delay healing, decrease appetite, increase stress, disrupt sleep, and ultimately cause anxiety and depression. These adverse physical health outcomes may make the patient eligible for using Oregon’s ‘death with dignity’ law.
Alex Schadenberg, executive director of the Euthanasia Prevention Coalition, warns, “I am convinced that ending opioid prescriptions for Medicaid patients in Oregon will lead to more requests for assisted suicide. When pain is not effectively controlled, people will experience greater levels of illness which will often lead to people becoming more desperate. Assisted suicide is a cheaper alternative to treatment. Dead people don’t require care.”