This article was published in PAINWeek News on September 8, 2012.
By Andrew Smith
New research isn’t the only thing that will change how pain specialists treat patients in the upcoming year. A wide range of recent legal, financial, and cultural factors may do even more to affect the standards of care.
Michael C. Barnes, JD, managing partner of DCBA Law & Policy in Washington, will outline the most relevant recent events and explain what they could mean for pain clinicians and their patients in his presentation this evening, entitled “Current Events in Law and Public Policy: Implications for Pain Care Practitioners.”
Insurers, courts, legislators, regulators, and journalists have become more interested in pain management recently, and they’ve taken many steps in the past year to exercise control over pain specialists and their patients.
“The number of potentially influential events is huge: hundreds and hundreds each year, certainly,” says Barnes. “The only way to make sense of them is to look for tends, and I’ve identified six big ones that people who treat pain should really be aware of and understand.”
The first issue, according to Barnes, is that more Americans are starting to worry about prescription drug abuse. He says that “Pain specialists may think they can’t possibly hear any more about the dangers of opioid abuse, but they haven’t heard anything yet. The issue has finally reached a tipping point in terms of mainstream media coverage, which means coverage will perpetuate itself, probably until the problem is ‘solved’ in the public mind.” Barnes notes that in the past year or two, “nearly every major newspaper in America has published articles highlighting the fact that prescription opioid overdoses kill more people each year than car crashes in some states,” along with other now-familiar factoids about the effects of prescription opioid abuse and misuse. In the wake of these news reports, celebrity overdoses continuing to make headlines, and sensational media accounts of “addicted babies,” Barnes says that “we’ve already seen an uptick in opioid-related legislation, regulation, litigation, and prosecution. And more is coming. Probably a lot more.”
Another important trend is that pain advocacy groups are losing funding and power. Barnes says that concerns about the opioid abuse problem were already deterring donors, even before this year’s public relations nightmare in which investigations shined a spotlight on the close ties between some pharmaceutical companies and advocacy groups. Oddly, these investigations come just as drug makers—worried that efforts to curtail opioid abuse will slash overall sales and profits—are cutting expenditures on pain advocacy. Pain advocacy groups are thus losing money from all sides at the very moment when their message about the importance of treating pain is falling out of favor. As a consequence, Barnes warns that pain specialists and advocates could see their ability to influence legislatures, insurers, and the public decline.
Additionally, addiction treatment may become a major component of pain care. Given that their expertise would, in theory, allow them to spot opioid abuse (or even potential abuse) early and help patients overcome any problems that develop, addiction counselors strike many as a natural fit for pain clinics. Unfortunately, few insurers cover addiction treatment, which creates financially feasible opportunities for pain practices that want to serve patients better (and potentially, reduce legal liability), either by hiring their own counselors or by contracting with third-party treatment programs.
“Most of the people in the audience probably are not going to like hearing most of what I have to say,” Barnes says. “But this is different. This is a real opportunity for caregivers.”
The greater legal risks faced by clinicians who prescribe opioids “too freely” is another trend that should concern PAINWeek attendees, says Barnes. Criminal prosecutions of both blatant pill mills and “careless” practitioners are on the rise. One doctor in California stood trial for second-degree murder after three of her patients overdosed. The local District Attorney argued that the doctor’s statement that there was nothing she could do to prevent a patient from taking a month’s worth of pills in one day amounted to a willful omission, and thus justified the murder charge.
Civil suits are also on the rise, both against doctors and insurance companies. In one case, a family landed survivor’s benefits from a worker’s compensation policy after their relative, who was prescribed opioids for an on-the-job injury, overdosed. Insurers are already beginning to increase restrictions on coverage of opioid prescriptions.
According to Barnes, tamper-resistant opioids are facing a make-or-break moment. This is important because, although early studies suggest that new formulations do indeed deter abuse, often quite dramatically, financial considerations may push such products from the market unless the government mandates that all opioids become tamper resistant.
Finally, Barnes says that clinicians who prescribe opioids will soon need extra training courses. A couple of states have already mandated new educational programs for anyone who prescribes controlled substances. Many other states are considering it, as is the federal government.
“The first trend—growing public concern about prescription drug abuse—underlies all the others.” Barnes says. “It will probably drive more changes to the industry than anyone can predict.”