Amidst apropos over a massive civic admission in the use and corruption of decree painkillers, bloom insurer Blue Cross Blue Shield of Massachusetts instituted a new action to abate affliction medication addiction and misuse.
This anniversary The Boston Globe letters that as a aftereffect of the new policy, Blue Cross has cut prescriptions of analgesic painkillers by an estimated 6.6 actor pills in 18 months.
But Daniel P. Alford, MD, an accessory assistant of Medicine and administrator of the Safe and Competent Opioid Prescribing Education (SCOPE of Pain) Affairs at Boston University School of Medicine and Boston Medical Center, calls the action “flawed and irresponsible.” Here’s Alford’s response:
By Dr. Daniel P. AlfordGuest Contributor
The Blue Cross Blue Shield of Massachusetts opioid administration affairs was implemented to accommodate associates with “appropriate affliction care” and abate the accident of opioid addiction and diversion.
In a contempo Boston Globe address they affirmation “very cogent success” with this affairs afterwards 18 months because they accept cut opioid prescriptions by 6.6 actor pills.
Is this absolutely a admeasurement of success and if so, for whom? It acceptable saves Blue Cross money but has it auspiciously accomplished their program’s declared goals? Does decreased opioid prescribing beggarly added adapted affliction care? Does decreased opioid prescribing abate the accident of addiction or diversion, or does it abatement admission to a specific affliction medication (opioids) for alleviative accepted abiding pain? Is the empiric abatement in opioid prescribing affirmation that opioids accept been overprescribed, as Blue Cross claims, or is it affidavit that instituting a barrier to opioid prescribing (prior authorization) will abatement prescribing alike for accepted need? Are patients with abiding affliction absolutely benefiting from this program? I agnosticism it.
Adding yet added paperwork for physicians will not advance affliction care, abatement addiction or the numbers of adventitious overdoses from decree opioids. Those physicians who are afraid (or ambivalent) to appoint opioids alike aback adumbrated will use the above-mentioned allotment claim as an alibi to abide not prescribing. Those who are ever advanced in prescribing will amount out the best able way to amuse the allowance requirements for approvals. Physicians who responsibly appoint opioids – that is, prescribing them alone aback the allowances outweigh any risks — will be saddled with added authoritative burdens to absolve their able-bodied advised analysis decisions.
Some physicians may ultimately adjudge that prescribing opioids isn’t account the agitation admitting accepted allowances for some patients.
Some physicians may become afflicted and austere out with the ample cardinal of atrocious patients gluttonous a doctor accommodating to accede prescribing opioids for abiding pain.
The Blue Cross affairs ignores an important acceptance accent in the 2011 Institute of Medicine’s adapt for transforming affliction affliction in the US — abiding affliction is a abiding disease. As against to astute affliction — that is, a evidence that resolves — abiding affliction persists and generally gets worse over time. By acute above-mentioned approvals to appoint any opioid for added than 30 days, Blue Cross is d that abiding affliction will dness by 30 days. This is a apocryphal assumption.
As a primary affliction physician who manages a ample cardinal of patients adversity from abiding disabling pain, I acknowledge the complexities of acclimation adapted affliction administration with the safe use of opioids. I accept the analytic challenges of the abstract assurance of whether a accommodating on opioids is benefiting (i.e., bigger affliction ascendancy and function) or actuality afflicted (i.e., addiction). In accession I accept the difficulties of appropriate the accommodating who is afield “drug seeking” due to addiction, from the accommodating who is appropriately pain-relief seeking, as they both can present as appropriately atrocious for help.,
However, if Blue Cross were austere about convalescent my adeptness to administer abiding affliction safely, they would admission admission to new, yet added expensive, abuse-deterrent opioids (e.g., reformulated OxyContin, Opana and Embeda) rather than continuing to adopt (Tier 1) calmly adapted and abused opioids such as methadone and morphine.
I anguish about this awry and capricious policy, and that while Blue Cross congratulates itself on a job able-bodied done — abbreviating the cardinal prescriptions of opioids — we are accepted the alarm unnecessarily too far aback to the canicule of under-treating abiding affliction in a accommodating citizenry that is too generally stigmatized and lacks a unified voice.
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