According to the Centers for Disease Control and Prevention, older adults, people with compromised immune systems, or those with chronic conditions are disproportionately at risk of serious illness or death resulting from the novel coronavirus (COVID-19).
Those populations also have one other trait in common: They’re far more likely to suffer from chronic pain due to conditions like HIV, cancer or simply advanced age.
Despite the declaration of the state of medical emergency by Health and Human Services Secretary Alex Azar, patients with chronic pain cannot — under current regulations in the United States — follow the advice given during pandemics, of stocking up on prescription medications and self-isolating.
Such policies unwittingly endanger the most vulnerable populations and increase the risk of death. Lifting the onerous restrictions on opioid prescriptions could potentially save thousands of lives.
Regulations on opiate-class medications have grown increasingly stringent over the last 15 years, in the vain hope of decreasing overdose deaths. Under current regulations, when a chronic pain patient does receive a prescription for an opioid, it is limited to 30 days.
There are no refills. The patient has to make an appointment with a doctor to get a new prescription, which must then be presented at the pharmacy in person. While rules vary by state, the prescription can, in general, be filled no earlier than day 28.
Moreover, the Drug Enforcement Agency, which sets the amounts of opioids that can be produced annually, has been steadily lowering the ceiling for the last several years.
Cuts in opioid production quotas have caused shortages, resulting in gaps in care, multiple trips, and even more exposure at a time when less social contact is critical. The justification is the “opioid crisis.”
The conventional narrative that prescriptions fuel addiction is unsupported by the evidence. The vast majority of overdose deaths result from a combination of multiple street drugs, and, quite often, alcohol.
Even as opioid prescriptions have been slashed in recent years, overdoses have increased dramatically, driven by illicit fentanyl analogs and methamphetamine.
Meticulous studies that matched overdose deaths to individual Prescription Drug Monitoring Program records in Massachusetts found that only 1 percent of overdose deaths had a prescription for an opioid.
There are similar data from Illinois and New Hampshire. Medical users are largely distinct from non-medical users.
The narrative that prescription opioids are the gateway to addiction nonetheless remains powerful. Chronic pain patients have become collateral damage in the perennial war on drugs. They, once again, could become the victims of stigma and pay the ultimate price of regulations that are unmoored from reason and facts.
Blue Cross Blue Shield has already announced relaxed rules on prescription refills. The American Pharmacists Association has also come out in favor of removing barriers to prescription refills.
Medication rules have already been relaxed for people with addiction receiving medically assisted treatment.
There is no change in barriers to access to medication by the high-risk population of chronic pain patients.
Continuing to enforce draconian restrictions on opiate-class medications in a way that increases the exposure of the highest risk population to a potentially deadly infectious illness that will further strain an already-strained health care system is contrary to common sense.
Ideally, chronic pain patients should be allowed to fill 90-day prescriptions, including door stop drops, followed by a telemedicine visit, which is now permissible. That cuts down sharply on exposure of medically vulnerable people. This might also require increases in production quotas.
Physicians writing these prescriptions for established patients should be given safe harbor from future investigations by state medical boards, the Drug Enforcement Agency, or any other law enforcement.
The Prescription Drug Monitoring Program is already in place, and there’s little fear of drug diversion. Again, it’s worth noting that patients are rarely the source of diversion of prescription opioids to illicit markets.
There are about 20 million Americans living with high impact intractable pain. More than 1 million Americans are HIV positive. There are almost 17 million cancer survivors. Further, almost 40 percent of women older than 75 live alone, making doctor and pharmacy visits extraordinarily burdensome.
There is no evidence that the current restrictions accomplish their expressed purpose of reducing overdose deaths.
During times of pandemics and public health scares, regulating without regard to scientific evidence or appropriate risk-risk analysis could have catastrophic consequences on the most vulnerable Americans.
