MEDICARE CHANGES MAY WORSEN OPIOID CRISIS
Every day, more news hits our papers and screens about the opioid crisis – how it continues to worsen, how various entities are struggling to fight it. As of early 2018, Medicare has been making plans to crack down on the overprescribing of opioids to its recipients. In 2016, an unbelievable one in three of the 43.6 million beneficiaries of the Medicare program’s drug plan had been prescribed opioid painkillers. Under the new rules, beginning in 2019, Medicare would not pay for long-term, high-dose prescriptions.
Critics of these changes say that the people really being punished are older and/or disabled Americans who have been relying on and properly using prescription painkillers. There are plenty of alternatives to opioid drugs out there, but many of them may not be suitable for people with chronic pain or particularly those with disabilities. For example, exercise – both aerobic and less strenuous activities like yoga – are often suggested to people trying to manage pain. Clearly, however, most people in their 70s or with degenerative diseases aren’t going to be able to do that sort of thing.
Another concern is that if people suddenly can’t get their hands-on prescription medication, they might turn elsewhere. Someone who stops taking opioid medications after a long period of use is inescapably going to go through withdrawal. This might send them in search of pills on the street, which are sometimes contaminated or otherwise unsafe. Also, many people who end up taking fentanyl or heroin started off on prescription meds and moved on to illegal drugs after their supply dried up.
Opioids need to be tapered off slowly, and the decision to do so is one that should be made between doctor and patient, not unilaterally by an insurance provider. Sometimes the benefit of a drug outweighs the possible risks when balanced against the pain relief and general increase in quality of life a person can achieve by taking opioids long term.
It should be noted that under the new rules, patients with cancer or in hospice are excluded from the seven day limit. For everyone else, coverage would be cut off after seven days of prescriptions equivalent to 90 milligrams or more of morphine daily. According to The Centers for Medicare and Medicaid Services, there are about 1.6 million patients currently with prescriptions at or above those levels.
An opposition letter was submitted regarding the rule change, signed by 220 professors in academic medicine, experts in addiction treatment and pain management, and patient advocacy groups. They argued that the possible benefits of fewer opioid prescriptions did not outweigh the risk of patients moving on to illegal drugs, or worse, committing suicide because of the withdrawal symptoms.
The rule must go through a required comment and review period, but if approved it will take place Jan. 1, 2019.
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