In March of this year, the Massachusetts legislature passed extensive changes to the state laws regarding opioid prescribing, use and abuse. This piece of legislation is Chapter 52 of the Acts of 2016, “An Act Relative To Substance Use, Treatment, Education and Prevention.” Most of the provisions of the law have already taken effect, although a few things will be going into effect over the next 6 months or so.
As most people in Massachusetts now know, opioids are medications to treat pain, but can also be misused and abused, sometimes with disastrous consequences. It seems almost everyone knows someone who has died from an opioid overdose. The “opioid epidemic” has been deemed a health care crisis, with some pretty horrifying statistics.
The law is wide-ranging, addressing how law enforcement officials and health care providers should respond to opioid overdose, the rights of patients NOT to receive opioid prescriptions, and programs for substance use education and screening in schools. There are provisions for holding insurance companies accountable for denying mental health care for substance abuse therapy, and for involving drug manufacturers in the collection and disposal of unused opioid medications. Pain management and substance abuse treatment will be studied, with the goal of improving access and effectiveness.
An in-depth discussion about how the law will affect Massachusetts residents is not something I can tackle here, but the big concerns for most people with chronic pain, and most providers, are the parts about how and when opioids can be prescribed. This actually takes up a relatively small amount of the law overall, and primarily addresses overprescribing and the documentation of opioid prescribing, and tries to make sure that opioid prescribing is done safely. There are concerns that the law will limit access to opioids to people who have chronic pain, but there is nothing specifically about discontinuing or reducing access for patients for whom opioids have become necessary to function.
The law places a significant responsibility on prescribers of opioids, in terms of justification of opioid therapy, documentation, patient education, and reduction in the risk of misuse and abuse. As a result, many providers who have been treating their patients with opioids are now reluctant to continue doing so, and are sending their patients to pain management specialists. This can be bewildering and frustrating for people with chronic pain, who sometimes feel as though they are being “punished” for the “crimes” of a few people. Insurance copays are frequently higher for visits to specialists, and often people with chronic pain are already seeing several other specialists, adding to the financial burden.
So in one sense, the new law could reduce access to opioids. In another sense, it is channeling folks with pain to those who specialize in the treatment of pain. Pain management specialists are often aware of treatments for pain that primary care providers are not, including new therapies. If opioid therapy is indicated, pain management specialists can prescribe opioids safely and effectively. In my experience, most people with chronic pain would be happy to stop or reduce opioids, if other therapies were available to manage their pain.
One of the obstacles to non-opioid therapies has always been insurance coverage. Opioids are cheap. Other medications and other therapies are usually not, even though they may be more effective, more sustainable and less risky. The new law, and a lot of public pressure, may start to encourage better insurance coverage for chronic pain therapies. Research on new therapies and medications for pain may also benefit when there is increased interest in finding alternatives to opioids.
Although this is a time of change and uncertainty, I am optimistic that we are moving in the right direction. Substance abuse disorders and chronic pain are separate conditions that both require intensive, long-term, specialized treatment, and as a society, we haven’t been doing very well at treating either one. Maybe that tide is about to turn.
At North Shore Pain Management we provide advanced, evidence based, multidisciplinary and cost effective pain management. Our goal is to improve your ability to return to the activities you have been missing as well as provide a meaningful reduction in pain.