Oregon Medicaid proposal would cut all opioids for chronic pain patients

Oregon officials are weighing a proposal that would eliminate opioids prescribed to chronic pain patients in the state's Medicaid program, according to STAT.

Here are six things to know:

1. The proposal outlines tapering chronic pain patients' opioids to zero over a 12-month period, starting in 2020. Instead of taking opioids, the proposal recommends shifting patients' pain management care to nonpharmacological therapies like chiropractic care, deep tissue massages or acupuncture.

2. State health officials declined to provide how many pain patients this policy could affect, but about 1 million Oregonians are enrolled in Medicaid. Nationwide, about 10 percent of adults experience chronic pain.

"We believe Oregonians in chronic pain deserve safe and effective pain management," Dana Hargunani, MD, CMO at Salem-based Oregon Health Authority, told STAT. "And at the same time, we're concerned about overdose and death, and we believe pain patients have been put at higher risk with regard to overprescribing."

3. Other states have passed legislation to cap first-time opioid prescriptions for acute pain to three, five or seven days based on the medical procedure. Yet, the proposed Oregon bill is the first of its kind to propose eliminating opioid prescriptions for patients who have not demonstrated signs of addiction or other negative health consequences.

4. Many chronic pain patients oppose the proposal, arguing it will drive individuals to seek illegal opioids, such as heroin, which is often laced with fentanyl, according to STAT. Chronic pain patient activists expressed concern that the task force charged with creating the proposal comprises three acupuncturists and a chiropractor. They said coverage for alternative pain management therapies provided by these types of clinicians should not come at the expense of opioid coverage.

5. Health experts are also skeptical of the proposal, citing little evidence on the benefits or consequences of taking pain patients off long-term opioids.

"What is notably missing is any review of any literature regarding the centerpiece of their proposed policy: Forced opioid taper to zero for all persons," Stefan Kertesz, MD, professor of preventive medicine at Birmingham based-University of Alabama School of Medicine, told STAT.

6. Oregon could approve the proposal as soon as October, according to STAT.

More articles on opioids: 

Johns Hopkins creates opioid guidelines for 20 common surgeries
Dr. Toby Cosgrove: Opioid epidemic has 'peaked'
EMS naloxone use jumps 75% in 4 years, CDC says

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