Response to the Surgeon General’s Opioid Pledge: It Misses the Point

turn tid ebonakdar twitterLast week, the Academy of Integrative Pain Management (formerly the American Academy of Pain Management) held its 27th Annual Meeting, educating attendees on a broad range of non-pharmaceutical treatments they could use to effectively, safely, and sanely treat patients in pain. Given the national furor over opioid prescribing, the meeting provided timely alternatives for nearly a thousand participants.

In his keynote session, AIPM’s immediate past president, Robert A. Bonakdar, MD FAAFP, Director of Pain Management at Scripps Center for Integrative Medicine and Assistant Clinical Professor at UCSD School of Medicine, addressed the evolution of alternative pain treatments used around the world and showed how they may inform and improve access to and quality of US pain care.

In his talk, Dr Bonakdar shared that on the same day he received the Surgeon General’s unprecedented letter to all physicians urging restraint in opioid prescribing, he also received two denials from insurance companies for patients to be treated with biofeedback and acupuncture – two proven-effective therapies.

In an op-ed just published in USA TODAY, Dr Bonakdar expounded further on his keynote remarks stating that, while over-prescribing of opioids and lack of insurance coverage for non-pharmacological treatments are problems, what the Surgeon General really needs to address is more fundamental – in the US, we have difficulty dealing with chronic pain. Period. Dr Bonakdar writes,

“Chronic pain is a complex scenario that not only affects the back or shoulder, but one that over time can shrink the brain while creating or worsening fatigue, insomnia, depression, anxiety, obesity and risk of suicide. The pain transformation called for by the IOM and most recently the National Pain Strategy requires not just a campaign, but an integrative, patient-centered approach to support someone whose entire existence is affected.”

The Academy of Integrative Pain Management has been a leader in advocating this approach to pain care since 1988 by training and educating clinicians. In addition, it is the only organization with three staff working full time on policy and advocacy at the federal, state, and local level to assure patients have access to integrative care that is paid for by insurance companies.

– The Academy of Integrative Pain Management

Follow Prescription Advisory

Prescription drug monitoring programs (PDMPs) are now active in most states to assist clinicians in identifying potential controlled drug misuse, diversion, or excessive prescribing. Little is still known about the ways in which they are incorporated into workflow and clinical decision making, what barriers continue to exist, and how clinicians are sharing PDMP results with their patients.

Design
Qualitative data were collected through online focus groups and telephone interviews.

Setting
Clinicians from pain management, emergency and family medicine, psychiatry/behavioral health, rehabilitation medicine, internal medicine and dentistry participated.

Patients
Thirty-five clinicians from nine states participated.

Methods
We conducted two online focus groups and seven telephone interviews. A multidisciplinary team then used a grounded theory approach coupled with an immersion–crystallization strategy for identifying key themes in the resulting transcripts.

Results
Some participants, mainly from pain clinics, reported checking the PDMP with every patient, every time. Others checked only for new patients, for new opioid prescriptions, or for patients for whom they suspected abuse. Participants described varied approaches to sharing PDMP information with patients, including openly discussing potential addiction or safety concerns, avoiding discussion altogether, and approaching discussion confrontationally. Participants described patient anger or denial as a common response and noted the role of patient satisfaction surveys as an influence on prescribing.

Conclusion
Routines for accessing PDMP data and how clinicians respond to it vary widely. As PDMP use becomes more widespread, it will be important to understand what approaches are most effective for identifying and addressing unsafe medication use.

Pain Medicine, Volume 15, Issue 7, July 2014 

A study was conducted to estimate the societal costs of prescription opioid abuse, dependence, and misuse in the United States. Costs were grouped into three categories: health care, workplace, and criminal justice.

The results: Total US societal costs of prescription opioid abuse were estimated at $55.7 billion in 2007 (USD in 2009). Workplace costs accounted for $25.6 billion, health care costs accounted for $25.0 billion, and criminal justice costs accounted for $5.1 billion. Workplace costs were driven by lost earnings from premature death ($11.2 billion) and reduced compensation/lost employment ($7.9 billion).

Conclusions: The costs of prescription opioid abuse represent a substantial and growing economic burden for the society. The increasing prevalence of abuse suggests an even greater societal burden in the future.

Pain Medicine, Volume 12, Issue 4, April 2011
Rick Bunker

Rick Bunker

Rick Bunker is a co-founder, and the CEO of Prescription Advisory Systems and Technology (P.A.S.T.). In this role, he is responsible for capital formation and corporate development.
Rick Bunker
Prescription Advisory Systems & Technology

Request a PastRx Demo

We will contact you to arrange a demo at your convenience.

You have Successfully Subscribed!

Prescription Advisory Systems & Technology

Contact PastRx

A representive will be in touch to answer any questions or concerns you might have.

Thank you! A Prescription Advisory representative will contact you shortly.

Share This