I’m the medical director for pain and palliative services at Doctor’s Hospital. I also see patients who suffer with pain in my private practice. And I’m board certified in emergency medicine with emergency room experience. Why am I reciting my resume? Because my work has put me squarely in the middle of the debate about opioid pain pills. Right now, part of that debate is taking place in the Ohio General Assembly, which is considering House Bill 248 sponsored by Representative Robert Sprague (R-Findlay) and Representative Nickie Antonio (D-Lakewood). Passage of this bill is important because there are safer formulations for opioid pain medication available and some insurance companies are making it hard for patients to get these safer medications. This needs to stop.
Everybody knows addiction to opioid pain pills has become a scourge in our communities. To help mitigate this problem, the Food and Drug Administration (FDA) is encouraging drug companies to make pills harder to abuse. Addicts like to crush the pill and snort or smoke it, or melt and inject it. Drug companies have found ways to make this very, very difficult. When a medication such as OxyContin is formulated to resist abuse, its street value drops dramatically and studies show the number of abusers also goes down.
By some estimates, 70 percent of the prescription medications that are misused are taken from a friend or family member, not acquired through an illegal street deal. So sending patients home with these safer kinds of pills, known as abuse deterrent opioids or ADOs, is clearly better for the patient, the family, and the community.
So what’s the problem? ADOs are more costly to manufacture than the same medication in its original form, so many insurance companies are refusing to pay for the safer but costlier version of the drug. This is a bad decision on so many levels. It makes it harder for communities to fight prescription drug addiction. It hurts abusers and their families by keeping dangerous drugs in circulation. And it actually increases health care costs. A 2011 study showed the average annual health care expense for an opioid abuser was more than $20,000 higher than for a non-addicted person, taking into account emergency room visits and in-patient hospital care.
House Bill 248 prohibits insurers from restricting access to ADOs based solely on cost. It also addresses the way Medicaid, which provides health coverage for low-income people, pays for prescription pain medications. By making ADOs more readily available, it will not only help address the addiction problem, it will also help my patients who legitimately need an opioid pain reliever.
It’s estimated that 100 million Americans suffer with persistent pain. That’s not counting those who have a temporary need for pain medications because of an injury, surgery or other short-term condition. When I see a patient in pain, my goal is to help him or her manage it in the safest, most effective way possible. When my decision is to prescribe an opioid pain medication, the safest option is an ADO formulation. Too often, my staff and I spend precious time on the phone arguing with an insurer who does not want to pay for it. When we are unsuccessful, the patient must either take a less safe medication or pay out-of-pocket.
As I said at the beginning, this needs to stop. People in pain don’t need the stress of arguing with their health insurance company on top of their medical challenges. Doctors who have made a careful decision based on direct interaction with the patient don’t deserve to be second-guessed by an insurer whose first interest is controlling costs.
It’s telling that House Bill 248 has bipartisan sponsors; neither pain nor addiction is a political issue. Rather, House Bill 248 is sound public policy and the legislature should enact it.
