The American Medical Association (AMA) recommended that the Centers for Disease Control (CDC) revise guidelines implemented in 2016 about prescribing opioids that they believe are harmful to cancer, sickle cell anemia, hospice and long-term pain patients.
The CDC is looking to revise guidelines on opioids later this year. Rethinking prescription drug policy may impact how workers compensation claim are administered.
In my view the insurance industry took advantage of the opioid crisis as an opportunity to change laws to their advantage. Laws regulating prescriptions effectively limit the cost of medical care and allow workers compensation insurers to wash their hands of ongoing medical expenses. Regulation of prescribing opioids was also floated as an idea to further employer-control of injured worker medical care.
AMA calls out pharmacy benefit managers
The AMA specifically mentioned how pharmacy benefit managers arbitrarily limit prescription doses. But even states that enthusiastically enacted measures to limit opioids were unhappy by the high prices charged by pharmacy benefit managers. But while drugs are regulated at a federal level, the Supreme Court appeared to give the greenlight to states looking to regulate pharmacy benefit managers over price concerns.
The “opioid crisis”: health crisis or moral panic?
In their release the AMA pointed out that while the CDC guidelines were meant to reduce overdose deaths from opioids, opioid overdose deaths have increased even as opioid prescriptions have decreased. It seems the driver of the overdose deaths is the opioid fentanyl. Fentanyl overdoes are 12 times higher than now than they were in 2012, according the CDC. The danger of fentanyl often comes from illegally produced and sold product.
Correlation isn’t always causation, but fentanyl deaths have risen as legal opioid prescriptions have decreased. This may be one reason why the CDC is rethinking their prescription opioid guidelines.
But if draconian limits on prescription opioids don’t serve public health, what purpose do they serve? Tarence Ray doesn’t answer this exact question in his recent article “United in Rage” about the response to opioid addiction in the Appalachian regions of Kentucky. Ray states that the response to opioid use wasn’t centered on treating people, but rather on criminally punishing users, community vigilantism and generally stigmatizing opioid users.
The AMA criticism of the CDC guidelines address how pain and pain patients are stigmatized through the CDC guidelines. Of course, injured workers are already stigmatized, so injured workers who need pain medication get doubly stigmatized.
Maybe a rethink of prescription opioid guidelines by the CDC, could lead to more humane treatment of injured workers in the future.
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