Opioid crisis involves legal, administrative and medical issues

That the opioid drug abuse problem in the United States is real and serious is one of very few things that goes pretty much undisputed in this fractious culture. Just what should be done about it, and who should be making the decisions, is another matter.

The most recent high-profile manifestation of that question was the announcement earlier this week that Express Scripts, the largest pharmacy benefits manager in the U.S., will limit the amount and strength of such pain medications provided to first-time users, regardless of what those patients’ doctors have prescribed. Starting in less than two weeks, patients prescribed opioids for the first time will be limited to a seven-day prescription of short-acting drugs.

There’s no question about the extent of the abuse problem. Federal Department of Health and Human Services figures for 2015, the latest year for which complete statistics are available, show that some 12.5 million Americans misused prescription pain meds, and more than 33,000 deaths were attributed to opioid abuse. Those are grim numbers indeed.

Express Scripts reports that its own pilot program from last year, involving more than 100,000 patients, showed a 38 percent drop in drug-related hospitalizations, and 40 percent in ER visits, for patients treated under the new prescription limits as compared to a control group. Dramatic results, to be sure.

What those statistics don’t tell us is the real-world human effect of such arbitrary limits on medications prescribed to relieve pain in patients suffering from a broad spectrum of illnesses and injuries. These are kinds and degrees of pain that their physicians deal with up close, and a prescription benefits company doesn’t see at all. (The policy would not, it should be noted, apply to cancer patients, or to people in palliative or hospice care.)

Among the organizations concerned about those arbitrary limits is the powerful American Medical Association, whose leadership, not surprisingly, thinks decisions about medication should be made by physicians, not plan administrators.

The AMA’s Opioids Task Force is chaired by Atlanta psychiatrist Patrice Harris, who told the Associated Press that doctors prescribing other forms of pain management along with, or as alternatives to, medication have reduced opioid use by 17 percent: "We want to be proactive in making sure the alternatives are available, versus a sort of blunt, one-size-fits-all-all approach regarding the number of prescriptions … The AMA's take has always been that the decision about a specific treatment alternative is best left to the physician and their patient."

That’s hard to argue with. Also hard to argue with is a part of the Express Scripts program designed to monitor patterns of “pill shopping” by patients who go from one doctor to another.

The issue, with medicine, generally comes down to the question of use vs. abuse. The appropriate clinical use of opiate medication, natural or synthetic, is to relieve pain. Abuse by some should not be a rationale for interfering with the medically sound treatment of others.

This story was originally published August 17, 2017 at 6:01 PM with the headline "Opioid crisis involves legal, administrative and medical issues."