The National Council on Independent Living’s Chronic Pain and Opioids Task Force supports legislative efforts to stem opioid addiction and overdoses in our community and increase access to treatment. While the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act of 2018, which was signed into law on October 24, 2018, does partially achieve that, we also have several concerns with this new law.
The SUPPORT for Patients and Communities Act furthers public safety goals including stopping the flow of illegal mail-order opioids and reducing the supply of counterfeit pills. This legislation also expands access to some addiction treatment and services through Medicare, Medicaid, and federal grant programs.
However, while the aims of the bills are widespread, many of the bill’s provisions focus on reducing opioid prescribing. We are disappointed there was no mention of the fact that most abuse occurs from pill factory activity and illicit opioid use, and not from people being prescribed opioids under supervised treatment for chronic pain. We advocate for continued access to appropriate controlled use of opioids for people with chronic pain under physician care.
NCIL has particular concerns about several provisions that focus on “outlier prescribers” within Medicare, particularly the sections recommending or requiring punitive action. Because most geographic areas have very few healthcare providers who prescribe long-term pain medication, these providers will, by necessity, be “persistent outlier prescribers.” Under this law, “persistent outlier prescribers” will be forced to make medical decisions based on arbitrary numbers instead of patient-centered risk/benefit analyses.
While diversion of opioids prescribed for acute pain is a serious public health hazard, long-term chronic pain management is not a primary driver of overdose or substance abuse. Opioid prescriptions for chronic pain do not correlate geographically with ER admissions for overdose, nor have overdose rates increased in demographic groups most commonly prescribed opioids for chronic pain. With opioid prescriptions at a 15-year low, illicit and counterfeit drugs account for the recent rise in overdose rates.*
Notably, the legislation mandates an evaluation of the impact of policies that limit opioid prescribing, including their unintended consequences on people with chronic pain and physicians. We are encouraged by this provision, particularly in light of the onslaught of recent limits that are one-size-fits all and appear – from anecdotal reports – to be affecting cancer and chronic pain care in implementation, even where such pain is exempted.
The SUPPORT for Patients and Communities Act of 2018 also improves federal funding for non-opioid pain treatments, which can help many patients. We strongly support investing in the development of new non-opioid alternatives as well as increasing access to existing non-opioid treatments. However, for some individuals, opioids are still the best option, often in combination with other modalities. People with chronic pain need access to the full spectrum of available options for pain treatment, as no single modality is effective for all people. As the federal government requires “persistent outlier prescribers” to “correct” prescribing practices, thereby further reducing access to opioids for people with chronic pain, these disabled Americans will lose access to a needed modality for pain management.
NCIL would like to see both regulatory safeguards and legislation to protect people with intractable pain and the providers who treat them, following the NCIL Statement of Principles on Chronic Pain and Opioids.
* Richard A Lawhern, Ph.D and John Alan Tucker, Ph.D., Analysis of US Opioid Mortality and ER Visit Data, CDC Wonder + AHRQ HCUP-US Databases (PDF), accessed October 15, 2018
