The opioid epidemic is the most pressing health crisis of our time, with the US Surgeon General, President Obama and the Centers for Disease Control and Prevention calling for greater awareness among clinicians, more treatment for the addicted or stricter guidelines for prescribing. This is an excellent and necessary start to the conversation, but to foster meaningful change and save lives now, we need to address a core issue – how we treat pain.
Our nation spends $635 billion on chronic pain, more than cancer and heart disease combined and our most prolific answer to treating pain is opioids, a low-cost narcotic that has very limited long-term efficacy data, and is known to cause abuse, addiction and death. In fact, since 1999 the number of prescription opioids has quadrupled without there being an overall change in the amount of pain Americans report.
We can reverse the opioid epidemic, but it will take a different strategy. By focusing on greater treatment for the addicted as our President suggests, our nation, with all our fantastic resources, will forever be playing catch up. We must first employ every suitable interventional strategy to treat pain before we turn to prescription opioids, regardless of their low up-front costs. We must also encourage greater physician education, private-sector innovation and health insurance cooperation.
Education needs to begin with primary care doctors, who prescribe more than 50 percent of opiates, but often lack the formal and practical background to understand when and why they should prescribe these narcotics. Frequently, primary care doctors escalate the opiate dose without coming up with a multidisciplinary treatment plan that will obviate the need for opiates. With more than 100 million Americans suffering from chronic pain, this approach must change.
Many times, there are interventional therapies that physicians could and should employ before a patient ever swallows his first pill. Neuromodulation options such as radiofrequency ablation procedures and spinal cord stimulators, have been around for decades and are proven effective at decreasing pain and opiate use while improving function.
Innovation will become ever more critical as we combat the opioid epidemic. We’ll need continued advances like we saw in July when the FDA cleared a new peripheral nerve stimulation device from SPR Therapeutics that allows doctors to use a threadlike wire inserted near nerves to stimulate specific nerve fibers, maximizing pain relief. It is the least-invasive neuromodulation option available, can be easily reversed, is drug free and provides sustained pain relief.
Another start up, Vertos, has developed a minimally-invasive decompression procedure that can remove certain types of spinal stenosis through a tube the size of a straw, removing the source of pain with a 20-minute procedure. The company conducted a randomized controlled trial demonstrating its efficacy, yet the procedure is still not covered by most insurers.
Innovative therapies, that provide hope to millions of chronic pain sufferers, are labeled ‘experimental’ by health insurance companies, irrespective of strong data supporting their use. The term “experimental” is used freely by insurers when they don’t want to pay for an effective, but more expensive therapy, as is the case when comparing to generic opioids.
It is imperative that health insurance companies put patients first and offer Americans effective and suitable alternative treatments for chronic pain. We can no longer allow these companies to use the platitude of lack of data as an excuse for not paying for innovative pain relief therapies.
After all, there is far more positive data on many interventional pain alternatives than there is on the success of opiates. New promising technologies must be reimbursed if we are to find our way out of this opioid crisis.
When you consider that the United States spends $72.5 billion annually on healthcare costs for non-medical use of opioid pain relievers, 78 Americans die every day from opioid overdoses and 1,000 people visit ERs every day for opioid overdoses, it begs the question, aren’t opioids too risky and expensive?
If clinicians, innovators and health insurance companies work together, we can replace abuse, addiction, fear and death with a hope-filled future.