We live and breathe pain policy, but with well over 1500 pain-related policies proposed across the country every year, and hundreds actually implemented (over 255 pain-related laws were passed in 2015, let alone rules, regulations, and guidelines), it can be far too easy to focus on what needs to be done rather than celebrate a job well done. Please join us for a moment to reflect on the positive impact that the Academy, SPPAN, and our extremely valued partner organizations have had over the course of 2015.
So, without further ado, 2015’s top policy successes in the field of pain management:
5. Supported prescription monitoring programs while ensuring their requirements are attainable.
The Academy recognizes the challenges involved in addressing two major public health crises, namely, inadequate treatment for pain, and prescription drug abuse, and to that end, has been heavily involved in both national and state-level efforts to address both health concerns. To address both issues, we have been strong proponents of the implementation and use of prescription monitoring programs. However, because obtaining and reading a report on a patient, even with the most efficient systems, takes 3-5 minutes, it is impracticable to require prescribers to check the PMP before every prescription, as it would create unworkable backlogs in physician offices, and would very likely overwhelm the capacity of the prescription monitoring program to provide the millions of reports that would be required. We expressed this concern to the Nevada Senate, alternatively advocating that the PMP should be checked when the initial prescription for a controlled substance is issued, and periodically thereafter, no less frequently than every 6 months. Ultimately, the legislature heeded our advice and amended their bill before its passage so that its requirements are realistically attainable by health care professionals.
4. Ensured patients with potential risk factors for substance use disorder receive appropriate treatment.
In developing practice guidelines for the treatment of chronic pain, both Vermont and Rhode Island proposed that a violation of a treatment agreement result in immediate prescription discontinuation and/or dismissal of the patient. However, current thinking in the medical community is that there should be a re-evaluation of the treatment plan, particularly with respect to controls in place related to medication use, as some people who engage in aberrant drug-related behavior are able to eliminate that behavior if their care is properly structured. After receiving our comments, both states now recommend a re-assessment of the patient’s treatment plan and alteration or institution of controls over medication prescribing and dispensing, which may include tapering or discontinuing the prescription. This ensures that patients are treated appropriately rather than left without the care and oversight of their health care provider.
3. Helped ensure that patients with a legitimate medical need for a controlled substance can access their medications.
Four years ago, the Academy first became aware of people with pain having problems filling their legitimately obtained prescriptions. As the years went by, the problem only worsened, so we at the Academy and SPPAN began convening stakeholders who could appropriately address the issue. After countless meetings, numerous trips to Florida, written and oral testimony, years of outreach, and the advocacy efforts of SPPAN, its partner organizations, and the work a much-appreciated journalist who shed light on the plight of those living with pain, the Florida Board of Pharmacy recently released new rules that aim to clarify the roles and responsibilities of pharmacists and help ensure that patients with a legitimate medical need for a controlled substance can access their medications.
2. Ensured those living with pain are entitled to the same level of care as those with other conditions.
Oftentimes, in a well-intentioned but misguided effort to “protect” patients with cancer and other potentially terminal illnesses, policymakers will propose policies for pain management that explicitly exclude those with cancer from their applicability. However, the Academy and its partners, including the American Cancer Society and the American Cancer Society Cancer Action Network, have argued in a number of settings, including in testimony submitted to the US Food and Drug Administration, that, in the context of opioid therapy, making a distinction between “cancer pain” and “non-cancer pain” is inappropriate, scientifically unsupported, and exposes cancer survivors to reverse discrimination. After making this argument to the Rhode Island Board of Medical Licensure and Discipline, the Board altered their rules related to pain management to ensure that all people living with pain, regardless of the etiology of that pain, be treated with the same high quality care.
1. Improved access to integrative pain care!
In 2015, both Rhode Island and Oregon passed legislation aimed at increasing access to high quality and affordable health care by prohibiting insurers from discriminating against any licensed health care practitioner acting within their scope of practice, entitling a long list of health care providers to reimbursement for their services. We are particularly proud of our work in Rhode Island—though their bill had been languishing untouched in Committee for months, it began to move swiftly immediately after we sent a letter to the House Committee on Health, Education and Welfare. With the help of SPPAN’s partner organizations, we were able to secure Governor Raimondo’s signature just before Rhode Island’s legislature adjourned for the year. In 2016, we will be on the lookout for any regulations that would implement these laws to ensure that they are drafted appropriately, and we will be working hard to pass similar legislation in even more states.
Wishing you Happy Holidays and a Healthy New Year,
Your Academy’s Policy and Advocacy Team