Health Care

Opioid crackdown said to leave out chronic pain patients

Chairman Johnny Isakson, of Georgia, speaks during a hearing of the Senate Committee on Veterans’ Affairs Sept. 26 in Washington.
Chairman Johnny Isakson, of Georgia, speaks during a hearing of the Senate Committee on Veterans’ Affairs Sept. 26 in Washington. AP

“It was a medicine cabinet that got him started and peer pressure that kept him on it,” Sen. Johnny Isakson said of his late step-grandson.

Isakson, a Georgia Republican, was telling a Senate hearing on pain management and the opioid crisis how his step-grandson had been addicted to opioids and died from an overdose.

The death toll for opioid overdoses rose from 8,048 in 1999 to 47,600 in 2017. That year, President Donald Trump declared the opioid crisis a national public health emergency, and recent attention from scientists and legislation from Congress has curbed the over-prescription of opioids.

But Cindy Steinberg, who has had chronic pain for 18 years and leads a chronic pain support group, said that the United States is facing two separate public health challenges: chronic pain and opioid abuse.

Tuesday, the Senate Committee on Health, Education, Labor, and Pensions considered the plight of people suffering from chronic pain who have struggled to access treatment since the crackdown on opioids.

But Committee Chairman Lamar Alexander, a Tennessee Republican, was not optimistic Congress could do much more at the moment.

He said the committee usually prefers to leave prescribing guidelines to states, physicians, and other agencies rather than create “inflexible federal laws.”

In March 2016, Centers for Disease Control set new dosage recommendations for opioids. Last year, Congress passed legislation that Trump called “the single largest bill to combat a drug crisis in the history of our country.”

The legislation authorized training for doctors who treat pain and increased access to behavioral and mental health providers. It also encouraged the use of short-term opioid prescriptions, such as three-or seven-day supplies.

However, the CDC guidelines and new laws to promote responsible prescribing practices can limit patients’ access to painkillers, said Committee Chairman Lamar Alexander, a Tennessee Republican.

At the hearing, Alexander read a message from a constituent whose wife couldn’t get a prescription for her chronic pain.

“She is not an abuser, and is doing everything right. Now it’s harder for her to get the medicine she needs,” the man wrote.

According to the CDC, 50 million Americans suffer from chronic pain, and 20 million have high-impact chronic pain that affects their daily work or life activities.

Steinberg urged the committee to dedicate more resources for pain research.

“At present, less than 2 percent of the NIH’s budget goes to pain research,” Steinberg said. “We really need an investment in research commensurate with the burden of pain.”

Other proposed ways to improve pain management options involve better embracing alternative treatments, such as acupuncture, behavioral therapy, or medical marijuana.

However, these treatments can be inaccessible or too costly. Dr. Halena Gazelka, an anesthesiologist at the Mayo Clinic in Minnesota, said that Medicare and Medicaid should expand coverage for non-opioid pain treatments.

“We are engaged in a massive bipartisan effort to make dramatic reductions in the supply and use of opioids — the most effective painkiller we have,” Alexander said. “But on the theory that every action has an unintended consequence, we want to make sure that as we deal with the opioid crisis, we keep in mind the Americans who are hurting.”