In Oregon, usually one of the more progressive states in terms of social policy, lawmakers in Salem are considering legislation that would end all Medicaid coverage for prescription opioids. Under the proposed statute, patients who depend on opioid-based medication for chronic pain management would have twelve months to taper off their prescriptions before coverage would stop altogether – regardless of whether or not they show signs of dependency or other health warning signs. If Governor Kate Brown signs the bill into law, it would go into effect in 2020.
The proposal has drawn sharp criticism by opponents who believe it will simply drive chronic pain patients to seek opioids illegally – including heroin, which often contains the dangerous synthetic opioid fentanyl. It may even put these patients at serious risk. They also point out that the proposed restrictions far exceed federal guidelines for opioid prescriptions in cases of chronic pain established by the Centers for Disease Control. These guidelines do not recommend that such patients simply be cut off at any time.
It should be noted that several other states have passed legislation restricting opioid prescriptions. Many of them have imposed limits on initial opioid prescriptions depending on a patient’s medical condition or treatment. The Oregon bill is the first to end a patient’s access altogether, however.
In an interview with STAT, Dr. Dana Hargunanin of the Oregon Health Authority said, “We believe Oregonians in chronic pain deserve safe and effective pain management…at the same time, we’re concerned about overdose and death, and we believe pain patients have been put at higher risk with regard to overprescribing.” As an alternative, the bill recommends that patients be switched to non-drug therapies, including acupuncture, massage and chiropractic.
Oregon is also one of nine states where marijuana has been fully legalized and CBD (the non-psychoactive component of the plant) is easily and inexpensively available. Last summer, the state of New York approved medical marijuana as a substitute for prescription opioids. Although formal clinical evidence of marijuana’s efficacy as a pain reliever is extremely limited, anecdotes from those suffering from chronic pain who have used it report almost miraculous results. However, marijuana remains illegal at the federal level, so currently, such an option would not be covered by Medicaid.
While Dr. Hagunanin is optimistic about opioid alternatives, other medical professionals are not as certain. Dr. Stefan Kertesz, a professor of preventive medicine at the University of Alabama, says, “What is notably missing is any review of any literature regarding the centerpiece of [Oregon’s] proposed policy” – which is essentially forcing patients to give up opioids within a limited amount of time. He would prefer to see additional research into this issue.
So far, the Oregon bill has yet to become law. Salem has not offered information on exactly how many Oregonians would be affected by such a law. However, there are 1 million people in the state who are enrolled in Medicaid – and according to national statistics, over ten percent of American adults deal with chronic pain issues. The proposal has sparked a number of protests from those who rely on prescription opioids for pain management.
Addiction is a complex issue – and the proposed Oregon law seems to be a “one-size-fits-all” solution. The existence of an opioid addiction crisis in the U.S. is not in dispute. However, forcing patients to quit their medication “cold turkey” without a full understanding of the consequences is ill-advised.