Oregon Chronic Pain/Medicaid Patients: PROP’s newest target?

“We have a law so that people in this state can have death with dignity,” Hix said. “Why don’t we have a law so that we can have life with dignity?”

https://www.bendbulletin.com/localstate/6403356-151/oregon-health-plan-considers-stricter-opioid-limits

Back in July of 2018 an article appeared on the Associated Press newswire: Oregon officials consider limiting opioid prescriptions. Originally sourced from the Bend Bulletin, the article states that Oregon could have some of the country’s strictest limits on opioids for chronic pain patients on the state’s Medicaid program under a new proposal. And the proposal was seriously terrible.

Oregon’s Chronic Pain Task Force proposed changes which would limit Oregon Health Plan coverage for five broad chronic pain conditions (fibromyalgia, chronic pain syndrome, chronic pain due to trauma, other chronic post-procedural pain and other chronic pain) to only 90 days of opioid pain medications, and would force patients who have been taking opioids for longer to be forcibly tapered off of those medications within a year. (The Oregon Chronic Pain Task Force was an ad hoc committee created to provide guidance on reducing opioid use under the Oregon Health Plan, and made its proposal to the Oregon Health Authority.)

State officials say the move is being considered to reduce the overprescribing of opioids, which has led to an epidemic of overdoses, and to provide alternative treatments previously unavailable to Oregon Health Plan members.

https://www.bendbulletin.com/localstate/6403356-151/oregon-health-plan-considers-stricter-opioid-limits

People in pain were understandably angry and upset. The state had made clear its plans to 1) remove access to prescription opioid analgesics to people in chronic pain on Medicaid and 2) to replace the medications with ‘alternative’ treatments – which typically show no efficacy towards reducing chronic pain symptoms through repeated studies and trials. What the state did NOT make clear was – who was behind this proposal?

“But Oregon’s proposal goes dramatically further — no other states or providers have such extensive proposals to remove patients who have not exhibited signs of addiction or other negative health indicators from their pain medication.”

https://www.statnews.com/2018/08/15/oregon-medicaid-tapering-opioids/

Why did Oregon’s healthcare officials propose that people in chronic pain were no longer deserving of pain relief, or that people should be categorically tapered down below certain doses regardless of the severity of their injuries or illnesses? Why, because the CDC had said so, of course!

(And to recap for anyone just joining us: How did the Centers for Disease Control and Prevention reach those conclusions about opioid dosage with those specific dosage limits? Because members of the nation’s biggest anti-prescription-opioid advocacy group, Physicians for Responsible Opioid Prescribing (PROP), infiltrated the CDC Core Expert Group and helped to author the controversial “CDC Opioid Prescribing Guidelines” – despite the obvious bias and conflicts of interest.)

If the PROP influence at CDC was the only impact to Oregon’s Health Evidence Review Commission (HERC) then . .. that would be one thing. (It wasn’t, and it isn’t).

By August 2018, chronic pain patients in Oregon were rallying and raising their voices to protest the draconian proposals. Well-respected pain experts and researchers were weighing in publicly about the the lack of evidence upon which the proposal was based and the needless suffering it would cause. The head of Oregon’s Health Authority dug in and defended the controversial plan (with his extensive background in medicine – no, wait – he is a business administrator, and his B.A. was in economics. So clearly qualified on medical matters of safety and efficacy). Fans of evidence-based medicine also snarkily pointed out why the Oregon Chronic Pain Task Force is so “open” to alternative treatments:

There are three acupuncturists (Ben Marx, David Eisen, and Laura Ocker) and a chiropractor (Mitch Hass) on the committee. Yes, you read that right. Four of the members of the Oregon Chronic Pain Task Force are quacks. They’re cruel quacks, too, as they want to force patients to taper their opioids in favor of their fraudulent “nonpharmacologic treatments for pain”.

https://sciencebasedmedicine.org/bait-and-switch-in-oregon-substituting-quackery-for-opioids-for-medicaid-patients/

Finally, a lone voice of reason emerged from the national landscape: Dr. Sean Mackey, MD, PhD, an all-around decent and dedicated scientist, anesthesiologist, pain medicine specialist and the Redlich Professor of Anesthesiology, Perioperative and Pain Medicine, Neurosciences and Neurology at Stanford took an unprecedented step: With the help of some professional colleagues and pain patient advocates, they collectively authored and submitted a letter to the Oregon HERC expressing deep concerns about the proposal to “force a vulnerable group of its citizens to taper off of opioids.” Dr. Mackey posted the draft and notified colleagues and interested parties that they could add their signature(s) to the letter if they so chose. Over a hundred people signed the letter within days, and the letter was submitted to Oregon’s Governor Kate Brown and various state healthcare authorities on May 6, 2019.

Net result? Oregon did a U-Turn. (No, really – that’s the headline: Oregon Does U-Turn on Opioid Tapering.) By May 16, 2019 – just 10 days after Dr. Mackey’s letter – Oregon HERC voted to table the proposal, and to scale back earlier recommendations regarding opioid tapering.

Is everyone celebrating in Oregon? Not quite. According to some reports:

But patient advocates say some doctors have already implemented HERC’s forced tapering proposal without waiting for it to be finalized.

https://www.painnewsnetwork.org/stories/2019/5/17/oregon-drops-opioid-tapering-plan

Pain patient advocates in Oregon – and all over the country – still watch and wait to ensure that other, similar attempts to limit medically-necessary medications are not successful. Patient and provider advocates await a clear and consistent acknowledgement from state and federal agencies that prescription opioids are not the primary cause of the overdose crisis, and for legislative and financial efforts to shift their attention to illicit fentanyl, heroin, and other street drugs – and to finding and funding evidence-based treatment for addiction and overdose prevention. And still we wait.

But how does PROP fit in to the Oregon story? Wait for it.

After the abrupt U-Turn by the Oregon Chronic Pain Task Force, the Oregon Healthcare Authority instead has initiated an ‘Opioid Tapering Task Force’. Several of the sitting members of this Task Force are simultaneously also leadership in Oregon Pain Guidance, a controversial group promoting the sweeping reduction of opioids for chronic pain without accounting for patient outcomes. The Oregon Pain Guidance website currently has opioid tapering guidance and tools authored by …. some VERY familiar names (from PROP, of course). The workgroup members listed include (but are not limited to):

  • Dr. Jane Ballantyne – University of Washington Dept. of Anesthesia & Pain Medicine – PRESIDENT OF PROP
  • Dr. Paul Coelho – MD Salem Health – Board Member, PROP
  • Dr. Andrew Kolodny – Brandeis – EXEC DIRECTOR OF PROP
  • Dr. Anna Lembke – Stanford University School of Medicine, Psychiatry and Behavioral Sciences and Addiction Medicine – Board Member, PROP
  • Dr. David Tauben – University of Washington Dept. of Anesthesia & Pain Medicine – Board Member, PROP

All of these people are members of PROP. Of the nine total members of the workgroup, five are PROP Board Members, including the President (Ballantyne) and Executive Director (Psychiatrist-not-pain-specialist Kolodny). A more thorough and entertaining analysis of the group can be found here.

Perusing this list, it’s as the Oregon HERC committee specifically sought the exact medical establishment people they knew would establish the result they wanted, period.
Result being zero opioids at all, natch.

https://medium.com/@heatherzamm/clarity-in-oregon-as-the-snakes-slither-in-8c2bcd6d8abf

Do we think PROP (and it’s individual members) are done wreaking havoc on chronic pain patients yet? You get one guess. Stay tuned.