Opiophobia is winning the war.

[Janice Reynolds]

) I was so thrilled when the Portland Press herald published the op ed piece I wrote recently (I sent on the link too you).  The other shoe dropped this morning; a two and a half page (full) story titled “I didn’t look like an addict”.  The report was about people who took opioids for pain and went to become addicted to heroin.  The whole article can be found here http://www.pressherald.com/2015/11/22/i-didnt-look-like-an-addict-former-state-trooper-says/  however especially concerning was the section where a pain management doctor was interviewed;

 

After more than a decade of skyrocketing opioid prescriptions for pain relief – starting in the late 1990s – research in the past five years has indicated that in many cases, the drugs do more harm than good, said Dr. Stephen Hull of Mercy Hospital in Portland.  About 15 years ago, the medical consensus was that these new opioids flooding the market were safe and effective at treating pain, Hull said. Pain was considered the “Fifth Vital Sign” and these new pills would eradicate pain.  The consensus was wrong, Hull said, and research now convincingly proves it.  Hull, Mercy Hospital’s pain management director, said he’s “troubled” to see that Maine doctors treating privately insured patients are still prescribing opioids for long-term pain, even though the MaineCare system has successfully cut down the supply of opioids for its patients.  “They don’t work for long-term, chronic pain,” Hull said, flatly. “If they don’t work, why are we prescribing them? Not only do they not work, there’s compelling evidence that they make the pain worse.” Hull referred to studies that showed that patients on long-term opioids reported worse pain than patients with similar diseases or conditions who were not taking opioids. While MaineCare patients are now much less likely to be prescribed opioids – the number of opioid pills prescribed in the MaineCare system nosedived 45 percent in 2014 when compared to 2012 – the same is not true of patients with private insurance. In the same time period, Maine patients with private insurers saw a 5 percent increase in opioid pills prescribed. The trend continues in 2015 for patients with private insurance. For the first six months of 2015, the latest figures available, private insurers had prescribed 24 million opioids, on track for 48 million opioids prescribed, compared to 44 million in 2014. By contrast, MaineCare prescribing rates for the first half of this year are flat compared to 2014, when 12 million opioids were prescribed to MaineCare patients.  “There’s a lag time in awareness,” said Hull, who helped develop the new MaineCare rules. “There are still doctors prescribing them.”  The lack of awareness is causing continued overdose deaths. Nationally, as prescription opioid abuse plateaued in the last few years, heroin deaths spiked while opioid deaths stayed about the same, according to the U.S. CDC.  Hull said the message has to get out to doctors who don’t see MaineCare patients that prescribing opioids for chronic pain is “not acceptable.”  Meanwhile, in the MaineCare system, doctors now have to jump through extra hoops to prescribe more than a 14-day opioid supply for their patients.  “If you want to prescribe more than 14 days, you have to justify it,” Hull said. “Anytime you can make the physician stop and think about what they are doing, that’s going to change behavior.”  Hull said once private insurance companies become more aware of the MaineCare rules that should help insurers change their guidelines to match MaineCare’s 14-day rule.  John Martins, spokesman for the Maine CDC, said the state is working to increase awareness of the prescribing rules.  “We’ve begun reaching out to some of the top insurers and educating them about our achievements in the Medicaid program,”

 

MaineCare is a nightmare; when they evaluated the program, nothing was looked at actually whether pain had been relieved or managed but only that fewer opioid prescriptions were written.  Bottom line is anything I had to say will be over ruled because this was said by a “doctor” not a “nurse”.  Unfortunately for people with pain everywhere these types of stories are appearing regularly across the nation.  Please note also the dig at “pain as the Fifth Vital Sign.”  Is it any wonder that people with persistent pain are living with anxiety, fear, and depression?  The big picture is really scary.

 

Janice