Finding a balance between providing needed care and avoiding overuse is not easy. In the face of an opioid crisis fueled in part by overprescribing, health care institutions and policymakers are rushing to restrict the opioid supply. However, some clinicians caution that these policies to curtail prescriptions aren’t taking into account what will happen to patients with chronic pain.
Dr. Stefan Kertesz is associate professor of preventive medicine at the University of Alabama at Birmingham School of Medicine, and will be speaking at the 2018 Lown Conference on a panel about the opioid crisis. Kertesz sees the effects of the new restrictions on patients who rely on opioids to function in daily life, and has been raising awareness about the consequences.
He explains that in the last two years, insurance companies, hospitals, and government agencies have tried to limit opioid prescribing by denying payment for opioids, regulating prescriptions, and sending the message to clinicians that it’s not okay to prescribe them. While these changes are a step in the right direction for limiting new patients’ unnecessary exposure to opioids, they have also made it more difficult for patients with chronic pain to get their regular prescription – and for some, leading to life-limiting pain and suicidal thoughts. “Every week I hear about patients about to commit suicide because they lost access to their pain medications,” says Kertesz.
Overprescribing opioids has undoubtedly contributed to the crisis; for example, doctors have provided unnecessarily large number of opioid pills after surgery. But the supply of opioids is not the only factor in addiction, and restricting supply doesn’t address the underlying crisis of despair in our country.
The conventional wisdom is that overdoses are caused by too many opioids, so reducing supply should reduce overdoses. But that’s not what the data show. “When we reduce prescriptions too quickly, patients go into withdrawal, kill themselves, go to the hospital,” says Kertesz, “And the rates of overdose don’t go down.”
So what should policymakers and health care institutions be doing to address the crisis? We need more comprehensive addiction services, access to methadone, and promoting pain treatments that de-emphasize pills, says Kertesz. Providers should also identify patients with elevated risk for harm from opioids and learn how to mitigate the risks.
“We love simple solutions,” says Kertesz, “But with opioids, these simple and attractive solutions aren’t working.”