At some point in their lives, 80 percent of adults will experience lower back pain. It’s the second most common reason that adults see a doctor and the most common reason for disability. It’s also a microcosm of all the things that are wrong with the U.S. health care system, including its contribution to the opioid crisis.

Having experienced lower back pain myself, I know that it can be truly debilitating. I would have done almost anything to rid myself of it. Lower back pain puts people in desperate and vulnerable positions, and it puts doctors under pressure to Do Something Now. From such a confluence arise many poor and potentially devastating treatments and choices.

Among the worst is doctors’ decisions to write opioid prescriptions as a treatment for lower back pain and their patients taking these drugs. Lower back pain is one of the most common reasons for an opioid prescription, but here’s the kicker: There’s no evidence that opioids are effective at treating this problem.

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At best, opioids mask pain in the short term. It’s like turning up your car’s radio to drown out the horrible noises coming from under the hood while you drive: The radio might distract you, but the car’s underlying problem isn’t getting addressed and could cause serious harm. And taking opioids for lower back pain often means its cause is being ignored.

A trio of papers published last year in The Lancet examined global issues in the prevention and treatment of back pain. One of them confirms the prevalence of opioids in treatment, saying, “Non-evidence-based practice is apparent across all income settings; common problems are presentations to emergency departments and liberal use of imaging, opioids, spinal injections, and surgery.”

What works best for lower back pain is a combination of education and proper exercise, not the overprescription of opioid painkillers. Yet to this day, health plans pay for such non-evidence-based interventions like opioids and make it difficult and expensive for patients to access evidence-based interventions such as physical therapy. That doesn’t make sense until you look at the reason: For the carriers that administer health insurance plans, there is far more profit in pills than physical therapy. (This also explains why the three largest pharmacy benefits managers have recently merged with insurance carriers.)

Our entire health care system is built on a vast web of incentives that push patients down the wrong paths. And in most cases it’s the entities that manage the money — insurance carriers — that benefit from doing so. They negotiate prices with health systems and pharmaceutical companies, all of which share the objective of increasing revenues, to craft and sell health plans that offer trumped up “discounts.” As long as carriers negotiate a high price with a provider or a rebate scheme with a drug maker, they can still make a sizable profit even after a 50 percent discount.

This dynamic was accelerated by the Affordable Care Act’s Medical Loss Ratio, which requires that 80 percent of insurance premium dollars pay for medical expenses and that carriers pocket only 20 percent. It doesn’t take much to see that the higher the premium, the more they make from that 20 percent.

By being more concerned about profits than patients, most insurance carriers’ plans are flooding our society with addictive drugs. And employers are blindly buying in.

There is an alternative, and some innovative employers have already taken action.

Rosen Hotels, for example, created a health plan for its employees that prioritizes proper primary care to better meet their needs — lower back pain among them. A key component of the company’s health plan is that instead of sending employees to volume-centric providers like status quo carrier plans do, it sends beneficiaries to value-based primary care physicians who are rewarded for positive patient outcomes and who prescribe treatments to address pain over pills.

Among the many benefits Rosen Hotels saw from this, one of the most impressive is that despite having employees with physically demanding jobs, the company was able to reduce opioid prescriptions so that they are one-sixth of those seen among employees of most other U.S. companies.

An estimated 700,000 people are likely to die from opioid overdoses between 2015 and 2025, making it absolutely essential to understand the connections between insurance carriers, health plans, employers, the public, and the opioid crisis. We will never get out of this mess unless we stop addiction before it starts, as Rosen Hotels is doing.

The core thesis of my latest book, “The Opioid Crisis Wake-up Call,” is that the opioid crisis isn’t an anomaly. It’s a side effect of our health care system. And while the enormity of the opioid crisis can certainly be discouraging, there is a silver lining: Since it is a microcosm of even larger health care dysfunction, those who are able to use their health insurance plans to tackle the opioid crisis can simultaneously solve health care’s systemic problems.

Dave Chase is co-founder of Health Rosetta, which aims to accelerate the adoption of simple, practical, nonpartisan fixes to the U.S. health care system, and author of “The Opioid Crisis Wake-Up Call: Health Care is Stealing the American Dream. Here’s How We Take it Back” (Health Rosetta Media, September 2018).

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  • What is with all this negativity about pain medications that work? I too have back problems. So much so that I’ve been on disability for 4 years. This is such a weak advocacy response for the infamous and never-ending Opioid Crisis. ‘They only “mask” the problem of pain? Oh, you mean so when you become productive from the pain being “masked” it’s not real productivity? Pain medications are WONDERFUL! They helped me lose weight by allowing me to get out of my wore out recliner that was supporting my lower back with a stack of pillows and become productive! YES, that’s right, I’m now HEALTHIER because of those EVIL opioids. The media is chock full of anti-opiate “experts” who want to discourage the use of pain medications. Your blatant misinformation has been noted. I’m doing great with my oxycodone and I’m not on the streets robbing people for my next fix!

  • I find it ridiculous that the powers that be say there is no evidence to prove opiods are effective. There is plenty of evidence to those in extreme pain that cannot get pain relief! I would suggest that studies should be done as with any other medication rather thank giving a blanket answer to all patients. I suffer greatly and cannot get pain relief. It is an outrage that medicine has become a political game of tug of war with the drug and insurance companies. You cannot say that all back pain can be treated by exercise. This article seems to have been written by someone whose never had chronic pain and that is it really isn’t it? People making decisions about things they cannot understand and so they judge instead.

  • This is nothing more than content marketing. There is a plug for a book, and a positive mention of a hotel chain. The owners of these hotels, big box stores, and other employers, know that injuries and “back pain” can be serious liabilities. They know that paying insurance claims could cut into their profits. They created a strategy to deal with it.

    They choose back pain, because it can mean almost anything, from occasional discomfort to serious structural injuries that lead to lifelong intractable chronic pain. In order to mislead us they re-framed it all. They deliberately conflated occasional discomfort that gets better with time, with structural damage to the nervous system. Researchers, funded with industry money jumped on, researching cherry picked selected subjects. They reported positive results even though the subjects with serious injuries dropped out of their “studies.” They knew that a certain percentage of “back pain” subjects will improve over time, whether they get alternative medicine, psychological interventions or other modalities. The main thing, was to get a positive result, however meaningless. They even came up with rat studies to back their spurious claims. Rat studies rarely translate to humans, and the only way to tell if a rat is in pain, is how the rat holds it tail up, and or swims. They used these same rat studies to justify the use of anti depressants too.

    I used to believe that science and facts would save us, but these distortions and perversions of science and facts, by industry funded researchers is destroying not only our health, but our objective reality. There are plenty of books on this so called crisis, each and every one distorts the facts to protect industry profits. It is no wonder that 22 years out, the problems are getting worse not better. It was not accidental that they conflated drug addiction and chronic pain. They had to smear everyone with chronic pain, and portray them as drug addicts. That way when a worker was injured, they could deny the claim. They even got physicians to dismiss MRI findings, as unnecessary, even when they contained images of structural damage or previous surgeries.

  • All this sounds like is an article to sell YOUR book… What would you recommend that I do? I’ve been through, physically therapy, shots, stretching acupuncture, surgery…. u name it, I’ve done it!

  • There is still time to send your comments to Washington. Curiously there was not one word about this on any of the Corporate Media sites like this, in spite of lot of people with serious pain commenting. Unfortunately the Feds have not listened to the Facts, as long as there is content marketing like this misleading the public.
    https://www.federalregister.gov/documents/2018/12/31/2018-28403/request-for-public-comments-on-the-pain-management-best-practices-inter-agency-task-force-draft

    Skeptic has a good article about the current misinformation being disseminated by greedy or intellectually challenged journalists, and marketers. There is a reason that 22 years have passed, since Purdues marketing campaign, and the current situation. This article even has a
    public relations plug for a hotel chain. Hotels typically fire their staff, when they are too injured to work, only managerial staff has insurance, not the people doing he physical work. Like other hotels, those staff members rely on Medicaid or Charity.

    https://www.federalregister.gov/documents/2018/12/31/hard working staff2018-28403/request-for-public-comments-on-the-pain-management-best-practices-inter-agency-task-force-draft

    • Alright Mavis. Submitted comment to hhs…
      Attn: other pain patients…
      Govt. is accepting comments from pain patients at:
      paintaskforce@hhs.gov
      Until 5pm est. today, april 1
      Let them know how important opioids are for your pain relief!

  • Profit motivation permeates our business culture. Insurance companies have, for decades, lobbied Washington for their own benefit, from instituting mandatory auto insurance and on and on. Big pharma distributors continue to spread opiods nationwide to “pain clinics”, where a few money-hungry dishonest doctors and pharmacists within the same buildings write and distribute opioids to addicts from nearby states. Criminals all. Until we get rid of the ability to lobby, with their exorbitant payments to their lobby personnel, things won’t change. Painkillers given to people who really need them to function (anyone who has experienced chronic debilitating pain, whether in the back or elsewhere, knows this is real and life-altering) will be the ones who suffer most. Restricting legitimate doctors from prescribing what their legitimate patients need is NOT the solution. Insurance companies and big pharma control the medical industry, NOT physicians and healthcare workers who are trained to treat people. I’m not sure what the solution may be, but getting decent, caring politicians in place would be the start, along with truly educating the public about how this untenable situation came to be. By not addressing addiction treatment and restricting presriptions, we are driving addicts to heroin and fentanyl, much cheaper alternatives. Propaganda about genuine pain, as demonstrated in this article, is damaging to the truth of this tragic situation.

    • Driving patients to the street. How unbelievable what they are doing. Its come to my understanding that the cartels are trying to provide a more legitimate opioid instead of all the toxic poisons. People risking their lives for relief and forced to deal with the underworld. What other group in our country gets discriminated against like this?!

  • T.trust! I thought I was done replying to you. Guess not. People like Mavis and others are providing extensive information to exactly what the problem is! Aren’t you seeing that?
    You are the one who is not providing anything useful or any solutions. READ the many responses that pain patients are giving! In many instances, opioids are the solution!
    We have to keep hammering away until we make this government listen to us. I’m not interested in being angry at you, but it just seems that you don’t have any feelings of mercy towards any of these suffering people and just seem to be playing some kind of game.

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