Contribute Try STAT+ Today

Hidden in the shadows of the Covid-19 pandemic is the U.S.’s drug epidemic, which is getting worse. One group that is paying the price for it, but shouldn’t be, are people who live with chronic pain conditions.

The opioid epidemic was initially fueled by the misuse of prescription opioids that were often obtained illegally. In recent years, though, the majority of overdose deaths have been caused by illegal or “street” drugs such as illicit fentanyl and its analogs, heroin, cocaine, and methamphetamines.

About a decade ago, in an effort to address the increase in opioid-related overdose deaths, government agencies at both the state and federal levels clamped down on prescription opioids in a misguided effort to tackle the crisis. The result? Numerous pain patients who were legitimate users of opioids were forced to stop taking these effective painkillers and left to fend for themselves. As a result, some of them turned to the black market, leading to far more overdose deaths.

advertisement

Data from the Centers for Disease Control and Prevention depict a disheartening trend. Overdose deaths have been rising steadily since 1999. Although there was an encouraging decline in 2018, in 2019 a record number of deaths were recorded.

Patrick Skerrett / STAT Source: CDC Wonder/National Center for Health Statistics

Worse still, the Covid-19 pandemic has increased social isolation causing widespread mental health issues, especially anxiety and depression. Not surprisingly, this has led to an increase in illegal drug consumption. Indeed, preliminary data from the CDC indicate that 2020 will see a record number of overdose deaths.

advertisement

Chronic pain can result from a multitude of conditions that cause severe neurologic symptoms leaving patients suffering and threatening their ability to function. This can lead to job loss, financial devastation, social isolation, chronic anxiety and depression, and suicide. In the U.S., approximately 50 million patients live with chronic pain caused by conditions such as injury, neck and back issues, multiple sclerosis, Parkinson’s disease, arthritis, autoimmune diseases, and more. Of these, 19.6 million live with what’s known as high-impact chronic pain, which affects their ability to work.

When I was the chief medical officer at the Department of Health and Human Services, I had the opportunity to chair the national Pain Management Best Practices Inter-Agency Task Force, a joint effort by HHS, the Department of Veterans Affairs, and the Department of Defense. The task force included pain experts, primary care doctors, surgeons, mental health experts, pharmacists, patients, veterans, and many others.

The seminal report from the task force, published in 2019, recommended a multimodal approach for patients in pain after an injury or operation, as well as for those with chronic pain and various underlying pain conditions. Recommended treatments include medications — non-opioid as well as opioid medications (while emphasizing safe opioid stewardship), interventional approaches, restorative therapies, behavioral health interventions, and complementary and integrative approaches. An underlying theme was that treatment must be individualized, and one size does not fit all.

The publication of best practices and the development of sound policies can ensure that health care providers have the knowledge and tools they need to help manage and provide treatment for those living daily with painful conditions.

But policymakers have lately been erecting roadblocks to treatment, such as prior authorization, that threaten some of these innovative approaches. If we do not act quickly to counter these actions, people who are already suffering from pain will suffer even more. By limiting access to these treatments, it affects their ability to perform activities of daily living including work, sleep, and other routines. Some will require additional medical care and hospital admissions, both of which will worsen their quality of life. Furthermore, these counterproductive actions will have a negative economic impact on our health care system, already severely strained by the pandemic.

Many pain specialists, including me, are concerned that recent announcements from the Centers for Medicare and Medicaid Services aimed at slowing the “overutilization” of safe and effective pain treatments will prevent Medicare patients from being able to access these non-pharmacologic treatments.

For example, CMS recently required prior authorization for therapies like Botox injections for people with chronic migraine who are being treated in outpatient settings. Even more concerning is CMS’s proposal to require prior authorization for neuromodulation treatments such as spinal cord stimulators in the outpatient setting. The effectiveness of neuromodulation — the electrical or pharmaceutical alteration of nerve activity — is backed by strong clinical evidence. It can reduce nerve-related pain and improve function among people with high impact chronic pain.

Prior authorization is a bureaucratic hurdle that delays access to safe and effective treatments for patients living with chronic pain, such as physical therapy, movement therapy, medications that help patients maintain functionality, and others. This is exactly what pain patients don’t need.

One of the many consequences of our nation’s response to Covid-19 has been the cancellation of nonessential procedures, which has limited access to non-Covid-19-related medical care. It has affected millions of Americans, and made matters worse for patients with painful debilitating conditions leading to worsening of pain, increased suffering, and poorer outcomes. Many of my patients who had been getting better have suffered severe setbacks. As recent data show, the improvement in the care of patients with Covid-19 has been countered by the negative impact of the pandemic on mental health, which has been caused by the unprecedented isolation that affected more than 310 million Americans at the height of lockdown restrictions.

Worse still, people who has been taking opioids safely for years to treat chronic pain continue to be subjected to forced tapering, meaning they are weaned off of opioids against their will, depriving them of a medication that can be lifesaving for those with complex neurological pain. Forced tapering can worsen medical conditions and some patients who legitimately and safely use opioids have been abandoned by their physicians. Add on the proposed CMS restrictions and we will inevitably see more suffering and more preventable deaths.

CMS must put a stop to this dangerous practice of limiting patient and provider access to therapies that they need and deserve.

Congress and several presidential administrations have made it clear that the health care community must use all of its resources to confront the opioid epidemic. To do so, clinicians need access to all of the safe and effective therapies that have been created by our nation’s innovators. Federal policies must not take us backward at this critical junction.

Instead, science and compassion are needed to address dueling public health crises: millions of people living with chronic pain and overdose deaths from the use of illicit drugs. This can be addressed by solutions that are right in front of us — if patients and their doctors can access them.

Vanila M. Singh is an anesthesiologist and pain management specialist at Stanford University School of Medicine, clinical associate professor of anesthesiology, pain, and peri-operative medicine at Stanford University, former chief medical officer at the Department of Health and Human Services Office of the Assistant Secretary of Health, and chair of the Pain Management Best Practices Inter-Agency Task Force.

  • I have 2 types of arthritis and nerve damage. I’ve ruined my health further taking otc meds. Trying to get something stronger is ridiculous. When I get sick, coughing for me can be a death sentence. Codeine is needed in the cough med to help me. Now I suffer horribly. Street drugs are sounding better and better. As a matter of fact I’ve already reached out to others to find me something for pain.. The medical community refused to help. Suicide looks great now.

  • Living with chronic pain is so very depressing and since our life saving meds are cut off it’s like living in hell. Unbelievable what our government has allowed.

  • Stop punishing people with chronic pain. If you force patients to stop using their doctor prescribed drugs there will be more dangerous illegal, and sometimes deadly consequences.
    I have multiple pain conditions that are treated with Norco. The doctors office requires signing several forms and the rules must be followed. I have no problem with that.

  • Thank you so much for writing this article. I have rheumatoid arthritis and although I live an active life, one or twice a month I could use one hydrocodone pill because of increased pain.
    Tramadol just doesn’t work.

  • I am older with RArthritus bone loss Scoliosis dissabiliy back bent over quite alot accident car knee surgery severe excrutoiating Pain
    especially in legs since Covd swelling inflammatio
    stiffnesss esp r leg blood circulation clotting ineed at times alot at times 4times aday an other times 2. Times a day an night never mind the criticism🙏

  • I was on opiates and morphine for over 20 years. Went to spiritual retreat in Texas 4 days kicked oct 13 2019 kicked the opiates. Then put on morfine 6 months when to Florida were I was treated with a Shaman with Kambo frog detox..lots of purging for 4 days and got off of morfine..then put on somboxa. Now with help from carpractor 3 days a week and the somboxa I am joining a gym, staring with trainer and treadmills and small amounts of weights I am doing better less depressed and able to get out of house even with covid 19. I hav finely found a day to day activity that has improved my quality of life..not hanging my head down and doing 75 percent better. please don’t give up and keep seeking treatment..find what helps you get your life together. Both of the detoxes in Texas and Florida will take you in without monies if you set and discuss your situation with them on a plan to make life more enjoyable.
    Now I am able to help others with my path to a new life at 63. Which I was ready to give up and die.. jus shows you can turn around your quality of life back. Please hang in there..yes I’ve traded one drug for another but I’ve got a new start in life.
    Remember periodically cleaning..at it’s not going to happen overnight. Per the ratio is if you been on opiates for 20 years it will take 5 years to get your life back..TIME people you jus don’t quit and it’s over keep trying don’t give up…there is help it jus doesn’t happen in months..yes everyone I’d different.
    Jus lik our eyesight everyone has a different prescription and shoe sizes.
    Per pain management in the year 2021 they are stopping opioids and morfine. thanks for the retreats and there use of plant medicine and the spiritual blessing they use.
    With love and peace be with ya ..
    Long road to recovery.
    Spiritual blessings and never give up.
    Kemosabe

  • Thank you with all my heart and soul for bravely maintaining a logical outlook in regards to those humans who have their lives turned upside down by neurological pain issues…such as my own misfortune of experiencing Reflex Sympathetic Dystrophy, which disregards any semblance of logic, and yet it totally controls one’s life style.
    The only medication that sufficiently decreases the symptoms happens to be opiates. Even a whopping dose of Neurontin 1,800mg doesn’t offer much help.
    Again, I THANK YOU for your stance.

  • I SUFFER FROM SPONDYLIOSIS. HERNIATED LUMBAR DISCS. CERVICAL
    SPURS, BUSTED SHOULDER,
    RIGHT ELBOW SPURS AND MASS GROWTH, KNEES GRINDING BECAUSE OF LACK OF CARTILAGE.
    FOR THE PAST 8 YEARS
    I HAVE BEEN ON A REGIMEN OF 20 MG OF OXYCONTIN
    I AT 7AM ANOTHER AT 7 PM.
    I HAVENT ASKED THE DOCTOR TO INCREASE MY DOSAGE, I FOLLOW THE PROTOCOLS OF STAYING
    LEGITIMATE TO THE DOSAGE. I USE TO PAY 40
    DOLLARS FOR 60 TABS PER MONTH NOW I PAY 484.00
    DOLLARS. IM 66, RETIRED BUT STILL HAVE TO WORK
    IF IT WASNT FOR A EMPATHETIC PCP DOCTOR
    I DONT KNOW WHAT I WOULD DO. AND I CANNOT
    BE LAID UP FOR MONTHS BECAUSE OF SURGERIES.
    I SUPPORT MYSELF.
    I HOPE THINGS GET BETTER
    CONCERNING THIS ISSUE,
    ME AND MANY OTHERS
    ARE NOT JUNKIES, BECAUSE THEIR IS A STIGMA OUT THERE. UNITED HEALTH
    OFFERED ME FENTANYL
    THAT THEY WOULD COVER
    INSTEAD OF OXYCONTIN
    AND I REFUSED. I AM A WELL INFORMED PERSON.
    I WAS NOT GOING TO
    TAKE FENTANYL.

  • Thank you for putting this out for people to read and get the real information of what is happening. I am a sufferer of chronic pain and am a victim of the weaning off. When I was able to get medication for my chronic pain my weight was 150 I was able to go out to eat with a friend or to go shopping a few days a week. I felt like as though I had some qàlity of life still. Now 2 years later I have gain 60 lbs. I rarely leave my home. All I can do is sit in a chair and watch the world pass me by. And am only 60 years old. And I won’t even get into the depression I now have and the feelings of helplessness and hopelessness. I don’t sleep well as the pain has me up every couple-few hours and I feel as though I am just taking up space nowadays. We need to turn things back around and let Drs do their jobs. I am not the only person who feels this way. I have heard from friends where their Drs have retired because they can’t practice medicine the way that they should. And the worse part of it is if you have chronic pain they do not want to prescribe medication only if it is pain from something that will eventually get better. We need help I feel as though nowadays I am just useless. I was very active before my medication was eventually cut off.

  • Great article. I have been with paun management for years. I have fibromyalgia, back problems and just had a knee replacement. There is not a day when I am not in pain. I am taking the lowest dose of Norco and have a butrans patch. It helps me to function. I try everything,such as yoga, walking, breathing exercises and asprin to try and help the pain. Heat ,ice and rubs. If I was taken off the medicine I don’t know what I would do. I was out for a week because of a mix up and pre authorization. I cried the pain in my knee and back were so unbearable. Wanted to give up. I never have abused my medicine. I try to only take if needed. They need to reevaluate. People who really need the medication should not be punished. I have been drug tested at least once a year. Never an issue.

Comments are closed.