More Opioids, More People in Pain
More Opioids, More People in PainMarch 6th, 2019 by Cindy Perlin
A recent study that examined long term trends in opioid use and incidence of pain found that as opioid use increased, so did the number of people in pain. The study found that over an 18 year period from 1997 to 2014 the number of U.S. adults suffering from at least one painful condition increased from 32.9 to 41 percent of the population. From 2001 to 2014, the use of strong opioids also increased from 11.5 percent to 24.3 percent of the population.
The study, conducted by the National Center for Complementary and Integrative Health and Yale University Medical School, did not speculate on the reasons for the simultaneous increases. For anyone familiar with the history of American medicine, the association between more people in pain and more opioid use is not hard to decipher.
How for-profit health insurance affects pain care
Those of us old enough to remember traditional health insurance, before managed care. can recall a time when almost all care from licensed medical providers was covered. The only exceptions were if the care was for a non-medical reason such as cosmetic surgery to improve appearance. Treatment decisions were collaboratively made by the physician and patient. It was the physician’s decision how long to spend with the patient, based on patient need. This allowed for adequate time to determine causation and make appropriate treatment decisions.
Legislation passed in 1973 paved the way for Health Maintenance Organizations (HMOs) and the first for-profit health insurance companies. By the 1990s, the prevalent model in health care became managed care, where health insurance companies claimed the right to make health care coverage decisions based on what they determined to be appropriate care. Although the justification for this was to control costs, the real motivation was to wring out the most profits as possible from insurance premiums.
Among the first moves HMOs made were to limit the number of covered visits to non-physician healthcare providers such as physical therapists, chiropractors, occupational therapists and psychotherapists. These are all treatments that benefit pain patients by addressing some of the underlying causes of chronic pain. These treatments must be pre-approved and copays are set higher than for physician visits. (Note: this changed for psychotherapy visits a few years after passage of federal legislation in 2008.) HMOs also set limits on the amount of time that physicians can be paid for spending time with patients
When pharmaceutical companies started promoting opioids as safe and effective for chronic pain, the health insurance companies decided opioids were cheaper than other kinds of care and cut back even more on nonpharmaceutical treatments. The most obvious casualty was multidisciplinary pain clinics, which had been proven to be the most effective method of pain care. Most had to close, with a reduction from over a thousand clinics to less than one hundred within a short period of time.
We have more pain patients because we’re not addressing the cause of the problem
Opioids numb pain, allowing pain patients who can tolerate them to temporarily feel better. However, opioids do nothing to address the underlying cause of pain. Pain conditions that could have improved with nonpharmaceutical care were instead left unchecked. This is the equivalent of shutting off the fire alarm instead of putting out the fire.
It’s no surprise then that the number of chronic pain patients continued to increase as opioids became the go-to treatment for all types of pain.