Pain management is one of the greatest challenges facing our healthcare system right now. We’ve witnessed tremendous growth in utilization trends stemming from the ‘perfect-storm’ effect playing out in this industry over the past several years, earning it the title of ‘last, wild, wild west of healthcare,’ as many like to call it. The unique and unprecedented combination of social, economic and clinical forces at work here have made pain management into a confusing and unmanageable entity by many of its key participants, namely payers, patients and providers.
In the U.S., pain is the number one complaint that drives patients to seek medical care. Despite this, many of the existing therapies and their supporting protocols for managing this population have not been standardized (or even validated) by objective clinical protocols or outcome analyses. This sustained, multi-directional growth has created abundant opportunity for special interest groups to determine and promote appropriate standard of care in many cases. The result is an extremely fragmented and unregulated industry where TV ads drive clinical decision making as much as peer-reviewed literature does.
On the economic front alone, we’ve seen double digit growth across many of the industry’s procedures and modalities that are commonly performed to treat pain. Accompanying this increase, there has been an alarming absence of literature or functional outcome assessment to support continued use of many of the therapies, especially at the rate at which many are currently being performed or prescribed. Additionally, close to half of all the pain procedures in the country are being performed by non-pain trained physicians or midlevel practitioners who have little or no quality control oversight in place.
When Investment Rhymes with Canada
Canada has a proud history of achievement in the areas of science and technology, and the field of biomanufacturing and life sciences is no exception.
The social scorecard is also grim. It reveals that opioid-related fatalities have now exceeded 17,000/year (4 times the number in 2000) and hydrocodone is the number one prescribed medication in the U.S. – for probably the 4th year running. These drugs are now killing more Americans than heroin, cocaine or car accidents, combined in many states. Addiction rates have responded by skyrocketing to an all time high, and many prescription drug users who become addicted are now turning to street heroin just to keep their withdrawal at bay. Drug-related crime is also on a steady increase, and more and younger kids are now trying these drugs in our schools. Even the incidence of NAS (neonatal abstinence syndrome) babies is rapidly increasing on an exponential curve across every state in the country.
To accommodate the almost certain and expected increase in future rates of addiction, the FDA seems to be approving more long-acting, high-potency opioids in early anticipation of increased consumer demand down the road. This in spite of and contrary to its own advisory board’s formal recommendation. This, at the same time governors and state addictionologists are holding impromptu press conferences to cry out and report their states epidemic proportion opioid addiction rates, and the associated, concurrent public access issues they’re experiencing for beds at treatment and detox facilities. Shortages they suffer since ‘they now need a rehab on every street corner of their cities.’
And as of late, we hear that multiple states are now lining up to file class-action lawsuits against the top 5 opioid manufacturers for false and deceptive reporting of adverse events related to addiction and for withholding the true and known addiction risk of the drugs they have manufactured and heavily pushed on everyone in this country and most civilized others for over a decade. Their marketing tactics were quite effective though – this handful of pharma manufacturers, the same group that divides up the $9 billion that just the U.S. spends on opioids every year (for pills that cost a fraction of a cent), has actually moved the national needle by markedly increasing the country’s addiction incidence rate by double digits in just as many years. All this for a drug that is not even shown to be effective for treating chronic pain. Instead, it seems to have spun off prospering subindustries like those focusing on urine drug testing services, providing cash pay methadone/suboxone clinics, or even providing huge boosts to entire other fields of medicine like addictionology.
Pain is a complex industry. It requires a specialized management solution.
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