While Covid-19 was ravaging our country over the past year, America was also fighting another epidemic: the ongoing battle against opioid abuse and overdose deaths. In fact, the pandemic has only worsened the addiction crisis, with over 88,000 Americans succumbing to drug overdose in the 12 months to October 2020.
As the country works to put the pandemic behind us, we must also work to combat the opioid crisis threatening small towns, large cities, and people of every age, race, and background.
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Eric Rosenberg Eric Rosenberg, DO, MSE is a cornea and complex anterior segment surgeon at SightMD.
Let’s start with expanding addiction education and assistance, reducing prescription frequencies and volume, and seeking non-opioid alternative therapies when appropriate.
Historically, doctors and surgeons have relied heavily on opioid-based pain medications. While opioids can play an important role for some patients, other methods of pain control are frequently overlooked—even when they are more appropriate for patient health and safety. That’s because financial incentives and the current healthcare structure encourage these potentially addictive drugs over non-opioid-based therapies such as long-acting local anesthetics, NSAIDs, physical therapy, and other therapeutic services.
These systematic policy incentives are a key driver of our national opioid crisis. According to an analysis of opioid-prescribing practices, approximately 3 million Americans annually become persistent opioid users following surgery.
There are other ways to manage pain. It’s time that health policy addresses the upstream causes of addiction by increasing access to alternative approaches that aren’t habit-forming or dangerous.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
For example, as ophthalmologists at large private practices and busy ambulatory surgery centers, it’s been exciting to see a safe, effective, FDA-approved anti-inflammatory and pupil-dilating drug that eliminates or reduces the need to use fentanyl – while reducing sight-threatening complications and improving overall surgical outcomes. According to a recent peer-reviewed study, this drug reduced the need for fentanyl during surgery by nearly 80% while decreasing patients’ pain scores by nearly 50% compared to traditional treatments. Another study, based on claims data on over 200,000 cataract surgery patients, showed that use of the drug decreased the number of postoperative opioids prescribed in these patients by over 50%. That’s fewer opioid tablets entering our community.
Yet, despite its proven safety, effectiveness, and ability to prevent opioid abuse, Medicare prevents many patients from taking advantage of this non-opioid alternative. In spite of robust evidence, Medicare considers the innovative drug to be a surgical “supply” like staples, stitches or gauze. By not reimbursing the treatment separately in hospital outpatient departments, Medicare creates a major disincentive for prescribing physicians and builds frustrating access barriers for patients. In turn, this dissuades ophthalmology practices from stocking it—meaning patients are subject to more painful surgical treatments and exposed to opioids unnecessarily.
This is just one example of how our nation’s healthcare policies undermine efforts to battle the opioid epidemic, and many other specialties can expand access to non-opioid alternatives as soon as Medicare’s policy changes.
To help solve this pressing issue, Congress recently introduced the Non-Opioids Prevent Addiction in the Nation (NOPAIN) Act (S. 586). This bipartisan legislation would mandate separate Medicare reimbursements for non-opioid treatments used in certain settings, empower patients with more treatment options, and allow physicians to still prescribe opioids as appropriate. Ultimately, reducing opioid prescriptions will help reduce diversion, addiction, and overdose deaths.
We know that the overprescription of opioids has fueled a crisis that has taken nearly half a million lives since 1999. Now, as hospitals begin working to reduce surgical backlogs, there is the danger of deadly addiction without access to non-opioid alternatives. We urge Congress to quickly pass the NOPAIN Act and help fight the opioid epidemic with the same fervor we’ve battled Covid-19.
Photo: Stuart Ritchie, Getty Images
Eric Rosenberg, DO, MSE is a cornea and complex anterior segment surgeon at SightMD.
