Back Pain and the Opioid Epidemic By Mrs Vera West
Hands up who has back pain … no, don’t that will hurt your back even more! Anyway, it seems that the opioid epidemic comes from people being in pain, especially back pain:
“The inappropriate treatment approach to back pain is a driving force behind the opioid epidemic, Dave Chase, co-founder of Health Rosetta, reports, citing the 2018 JAMA Network Open paper, “Opioid Prescribing for Low Back Pain: What Is the Role of Payers?” One of the reasons for this is the sheer prevalence of back pain. Statistics suggest 8 in 10 American adults will be affected by it at some point in their life. “It’s also a microcosm of all the things that are wrong with the U.S. health care system, including its contribution to the opioid crisis,” Chase writes. “Lower back pain puts people in desperate and vulnerable positions, and it puts doctors under pressure to Do Something Now. From such a confluence arise many poor and potentially devastating treatments and choices. Among the worst is doctors’ decisions to write opioid prescriptions as a treatment for lower back pain and their patients taking these drugs. Lower back pain is one of the most common reasons for an opioid prescription, but here’s the kicker: There’s no evidence that opioids are effective at treating this problem.”
Opioids Are Inappropriate for Back Pain
Indeed, according to the JAMA paper:
“Recent data from the first randomized clinical trial with long-term outcomes demonstrated that opioid treatment did not confer benefit with respect to pain-related function and that adverse medication-related events were more common among patients receiving opioid therapy. In contrast, pain intensity was improved among patients randomized to nonopioid treatment.” Other research published in 2018 also shows opioids (including morphine, Vicodin, oxycodone and fentanyl) fail to control moderate to severe pain any better than over-the-counter (OTC) drugs such as acetaminophen, ibuprofen and naproxen. In fact, those taking nonopioid pain relievers actually fared “significantly better” in terms of pain intensity. Lead author Dr. Erin Krebs with the Minneapolis VA Center for Care Delivery and Outcomes Research (formerly Chronic Disease Outcomes Research), told WebMD: “We found that opioids had no advantages over nonopioid medications for pain, function or quality of life in patients with low back pain … This is important information for physicians to share with patients who are considering opioids.”
How Insurance Companies Contribute to the Opioid Crisis
Despite the medical consensus that back pain is best treated with nonpharmacological means, most insurance companies still favor opioids when it comes to reimbursement. As noted in the American College of Physicians’ guideline “Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain,” heat, massage, acupuncture or chiropractic adjustments should be used as first-line treatments. When drugs are desired, nonsteroidal anti-inflammatory drugs (NSAIDs) or muscle relaxants should be used. Other key treatments include exercise, multidisciplinary rehabilitation, mindfulness-based stress reduction, tai chi, yoga, relaxation, biofeedback, low-level laser therapy and cognitive behavioral therapy. In a recent episode of Full Measure, Sharyl Attkisson interviewed Eileen Kopsaftis, a physical therapist who uses a combination of diet, connective tissue work, proper body dynamics and body balance to address back pain. As for opioids, they “should only be considered if other treatments are unsuccessful and when the potential benefits outweigh the risks for an individual patient,” according to the American College of Physicians’ guideline.
Alas, while clinical practice guidelines call for nonpharmacological intervention for back pain, most insurance plans don’t pay for such treatments. They do pay for opioids, though. In his article, Chase explains:
“That doesn’t make sense until you look at the reason: For the carriers that administer health insurance plans, there is far more profit in pills than physical therapy. (This also explains why the three largest pharmacy benefits managers have recently merged with insurance carriers.) Our entire health care system is built on a vast web of incentives that push patients down the wrong paths. And in most cases it’s the entities that manage the money — insurance carriers — that benefit from doing so. They negotiate prices with health systems and pharmaceutical companies, all of which share the objective of increasing revenues, to craft and sell health plans that offer trumped up ‘discounts.’ As long as carriers negotiate a high price with a provider or a rebate scheme with a drug maker, they can still make a sizable profit even after a 50 percent discount. This dynamic was accelerated by the Affordable Care Act’s Medical Loss Ratio, which requires that 80 percent of insurance premium dollars pay for medical expenses and that carriers pocket only 20 percent. It doesn’t take much to see that the higher the premium, the more they make from that 20 percent … An estimated 700,000 people are likely to die from opioid overdoses between 2015 and 2025 making it absolutely essential to understand the connections between insurance carriers, health plans, employers, the public, and the opioid crisis. We will never get out of this mess unless we stop addiction before it starts … the opioid crisis isn’t an anomaly. It’s a side effect of our health care system.”
Thus, the basic way the health system is structured around Big Pharma having a drug to deal with a complaint, leads to situations like the present opioid crisis. The alternative approach to health would involve physical therapy, exercise, and life style changes, which are not easily packaged in one quickly swallowed pill, and one not as profitable.