Chronic pain patients receiving opioids through Medicare and Medicaid might soon be cut off, and hundreds of doctors are warning the agency that doing so could have dangerous consequences.
The Center for Medicare and Medicaid (CMS) announced plans to restrict opioid prescriptions to a maximum dose equal to 90 milligrams of morphine a day. For a popular opioid like hydrocodone, that would be about nine pills.
“This is just a knee-jerk reaction,” Dr. Ajay Manhapra, an addiction medicine fellow at Yale University, said. “One thing is assured, a lot of people on long-term opioids are going to suffer quite a bit.”
Dr. Manhapra helped write a letter to CMS outlining the possible negative effects the new policy could have on chronic pain patients who are already prescribed more than the restricted amount, which according to CMS data is over 500,000 people.
"People with these complex set of problems will be abandoned, and they'll be either bed-ridden, or a lot of them will likely have adverse medical outcomes. They will have adverse psychiatric outcomes. There will be increased suicide among them," Dr. Manhapra said.
Now, the letter has received at least 220 signatures, including eight officials who helped develop the 2016 Center for Disease Control guidelines on prescribing opioids.
One of those officials is Dr. Jane Ballantyne, and she said the proposed CMS policies are “too ruthless” for those patients who are already dependent on opioids, which is something the CDC guidelines had factored in.
“The CDC guideline does make note that if somebody is already taking opioids that those rules don’t really apply because they already are taking opiates, and therefore they are already opiate dependent, and you can’t just cut them off if you wouldn’t have given them opiates in the first place,” Dr. Ballantyne said.
She said the CDC recommendations are meant for patients just starting to take opioids, not patients who have already been prescribed high doses of the pain killer.
“If we just tried to reduce everyone who is already on high doses of opiates to the dose level that the CDC is recommending, you would have an awful lot of people who are either suffering a lot or going to the street to get heroin, neither of which is a very good result," Dr. Ballantyne said.
In a statement to Circa, CMS principal deputy administrator for Medicare and director of the Center for Medicare Demetrios Kouzoukas said the agency has already been successful in reducing the misuse of prescription opioids, and the new policies are meant to continue reducing the risk of addiction for Medicare patients while continuing their treatment options.
In 2016, one-third of Medicare Part D patients had been prescribed an opioid, according to a Health Department Inspector General report published in 2017.
Dr. Manhapra said nobody in the letter is denying the widespread abuse of opioids and the harm it has caused, but since many states have already enacted laws meant to reduce the number of opioid prescriptions, so the new CMS policy would only take pain killers away from people who actually benefit from them.
“People who are gonna use heroin and fentanyl are gonna go ahead and use it. People who are really dependent on opioids, because there is no access to treatment, they are gonna move on to heroin. Only set of people this is going to affect is a lot of people who are stable on this medications,” he said.
Since 2012, the number of opioids prescribed in the U.S,. has steadily decreased while the number of fatal drug overdoses has continued to increase.
The policy is set to be finalized in early April, and Dr. Manhapra said if the changes he is advocating for are not made, he will continue to speak out against the policies.
"At the end of the day, we are doctors. We have to be advocates for our patients,” he said.