December 12, 2018
ASA Concerned with Oregon Policy to Restrict Opioids for Chronic Pain Patients
Last week, Oregon’s Chronic Pain Task Force advanced a policy that would limit opioids for Medicaid patients despite ASA concerns that this force-tapers certain Oregon Health Plan patients to zero, as described in formal comments ASA submitted to the Task Force ahead of the meeting where the proposal was discussed.
ASA, the Oregon Society of Anesthesiologists and the California Society of Anesthesiologists worked together to formulate a response to the Task Force’s original policy and were pleased to see that it was modified prior to the recent meeting. However, concerns remain with this approach.
In comments to the Task Force, ASA expressed concern regarding a blanket policy that bans an entire class of medications, regardless of individual patient needs. The Society also cautioned against the negative effect on patients; a forced taper can impact both patients’ health and wellbeing. ASA questioned why Oregon would choose a route in which the Task Force has acknowledged there is little evidence or studies to support such a policy.
While treating chronic pain, patient care should be the greatest priority. Individual physicians and their patients should choose a treatment plan and modality after jointly discussing options, benefits and risks. ASA is concerned this policy is too extreme for certain chronic pain patients. Pain medicine specialists should decide when tapering is appropriate for their patients.
At their meeting on December 5, the Task Force acknowledged the proposal should be individualized to patients and that the taper rate and timeframe should be at the discretion of the physician and their patient and not viewed as a mandate. ASA finds this encouraging but cautions the state to be explicit in their final policy to ensure the implications to patients do not have unintended consequences.
Also promising, during this same meeting, the Task Force discussed expanding alternative treatments for certain chronic pain conditions, a premise ASA has long-recommended to policymakers— chronic pain patients need opioid alternative options, including interventional therapies, that are covered by both public and private payors.
The opioid taper policy advanced by the Task Force will be considered by additional subcommittees of the Oregon Health Authority in the coming months and likely brought before the legislature as well. A final policy would not be enacted until January 2020.