“Doctors just say, ‘That’s it, I’m done. I’m not going to lose my license over you and good luck,’ and that’s unconscionable,” said one health expert.
The opioid epidemic has drawn more political and media attention than any other public health crisis in recent memory, but healthcare professionals say that the focus on preventing opioid-related deaths is having unintended consequences for patients dealing with other conditions including cancer, chronic pain and other forms of substance use disorder.
One of the biggest concerns is that patients are being taken off their opioids too quickly, which can increase physical symptoms of withdrawal and leave patients feeling overwhelmed by the idea of quitting.
“Some people will be tapered too quickly or in a way that is intolerable to them,” Elinore McCance-Katz, the Health and Human Services assistant secretary for mental health and substance use, told Politico.
Sally Satel, a psychiatrist and Yale University School of Medicine lecturer, said that some doctors are less understanding of slowly tapering patients because they’re concerned about their own liability.
“I’ve seen patients where doctors just say ‘That’s it, I’m done. I’m not going to lose my license over you and good luck,’ and that’s unconscionable,” she said.
Although policies have shifted to focus on non-opioid pain relief, these options are still less likely to be covered by insurance, leaving patients with chronic pain with few options.
The Department of Veterans Affairs and the Defense Department have begun paying for alternative care, but “beyond that it’s pretty much just been lip service and it’s a little challenging how to craft legislation that affects what private payers are able to offer in this arena,” said Bob Twillman, executive director of the Academy of Integrative Pain Management.
“It’s one thing for an insurer to cover [an opioid alternative]. It’s another thing to cover it at a co-pay that the patient can afford,” said Cindy Reilly, who recently left the Pew Charitable Trust, where she focused on issues around opioid use and access to effective pain management. “We need to stop making opioids the easy decision—in terms of writing prescriptions and patient access. Higher co-pays will stand in the way.”
Sean Morrison, chairman of the geriatrics and palliative medicine department at the Icahn School of Medicine at Mount Sinai, said that he is increasingly seeing hospice patients unable to get the opioid drugs needed to make their end of life more bearable.
“Almost every patient I have prescribed for recently has either a) run into pharmacies that no longer carry common opioids; b) cannot receive a full supply; and c) worst of all had their mail order pharmacy refuse to fill or have had arbitrary and non-science based dose or pill limits imposed,” he said.
Joe Rotella, the chief medical officer for the American Academy of Hospice and Palliative Medicine, agreed.
“Even with exemptions for hospice care, prescription limits are still having an impact,” he said. “Patients have a tougher time getting these medications and it’s a lot more hassle for providers.”
Cancer patients are also being affected as hospitals experience a shortage of IV fentanyl and morphine.
Finally, the focus on funding interventions for people abusing opioids has deflected money from other drug-intervention programs. This is especially problematic in areas like the Southwest, where overdose deaths from methamphetamine are rising sharply.