High costs pose barriers to opioid alternatives

Amid growing concern over the national opioid abuse epidemic, physicians are looking at alternatives for managing patients' chronic pain. However, there seem to be few viable options for managing acute pain, and chronic pain patients must navigate significant financial obstacles to access less addictive treatments, according to the Charlotte Observer.

"There haven't been any new developments in pain medication — like a novel class (of drugs) — since I've been in practice," Nathan MacDonald, MD, chief of emergency medicine at Lowell (Mass.) General Hospital, told the Charlotte Observer. "You would think there would be money in it for the pharmaceutical companies, but I haven't heard of anything on the horizon for acute pain."

While over-the-counter medications like Tylenol or Advil can effectively treat acute pain, such drugs pose their own potential health problems. Taking too large a dose can lead to long-term issues such as kidney or liver damage, according to the report.

At the surgical level, many physicians have begun adopting Exparel, a non-narcotic anesthetic that can be injected during the procedure and keep the surgical site pain-free for two to three days and costs around $300 per dose. Another non-narcotic that can be used during surgery is Ofirmev, an intravenous form of acetaminophen, which costs $35 per dose. In comparison, the average Vicodin prescription in the U.S. cost $5 in 2015, according to IMS Health data, the Charlotte Observer reported.

Opting for alternative pain management options can ultimately save hospitals money in the form of shorter length of stay, earlier ambulation and discharge to the home instead of a long-term care facility.

But for patients, innovative pain management treatments such as acupuncture or massage therapy are often not covered by insurance companies and remain too expensive for patients.

"If I had more tools in the toolbox, I could avoid opioids even more," said Hugh Silk, MD, a family physician at UMass Memorial Medical Center in Worcester. If we're really going to fight an opioid epidemic, we can't keep Percocet inexpensive and Lidoderm (a local anesthetic) patches expensive."

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