Where will PROP strike next in its ongoing efforts to limit prescription opioids to people in pain? After their efforts in Oregon, where might they try next to impact chronic pain patients who have been stable on long-term opioid therapy?
If you guessed the PROP home state of Washington you were right. See this PDF comparing PROP members to the agenda of an upcoming medical conference in Vancouver, Washington on August 9, 2019:
The “Patient-Centered Approach to Chronic Opioid Management” is a one-day conference on August 9th tacked on to an existing HHS Region 10 Opioid Summit in Vancouver, Washington August 7-8th. Where the HHS Opioid Summit Agenda lists panels and updates from regional health representatives, the “Patient-Centered” Agenda . . . . looks entirely different.
First, with rare exceptions virtually every speaker on the agenda is 1) A member of the PROP anti-opioid group, 2) A member of the CDC Opioid Guideline authors or Core Expert Group, or 3) a member of the Oregon HERC or Oregon Pain Guidance groups, the people who proposed – and eventually retracted – the Medicaid forced tapering plans.
Biased Speakers’ List
This speakers list alone is enough to be VERY concerned. Historically PROP’s efforts have been incredibly biased, and Oregon’s recent history regarding chronic pain and long-term opioid therapy is … troubled, at best. The CDC has now admitted that their guidelines were ‘misinterpreted and mis-implemented’ but remain defiant that there was nothing at all wrong with them. Given those contributors what will the theme of this conference be on the day?
Lack of Scientific Evidence
In addition to the concerns about bias there is a serious problem about the lack of scientific evidence to discuss: there just isn’t very much evidence about long-term opioid therapy safety and efficacy, and even less about tapering guidance. We all now know – due to recent strong statements from the FDA, AMA, HHS, and CDC – that rapid tapering and patient abandonment is dangerous and even deadly for patients. If the conference is patient-centered shouldn’t it also be evidence-based?
Where did the funding for this one-day conference for chronic pain patients originate? Funding comes from a Federal grant to the Division of Behavioral Health and Recovery: a division of the Washington State Healthcare Authority which integrates state-funded (Medicaid) services for substance use, mental health, and problem gambling. Rumor has it that it was a $50,000 grant intended for addiction prevention, treatment, and recovery and instead it is being used to discuss chronic pain patients on long-term opioid therapy. With 99% of well-screened chronic pain patients never becoming addicted to opioids . .. that just seems like a waste.
With $50,000 of federal funding for addiction treatment Washington state could have instead purchased 1,600+ doses of Naloxone. (Assuming an average cost of $30 per dose of generic Naloxone). That would have covered twice as many doses Washington state needed to reverse overdoses in 2016.
Do we think that chronic pain patients who are successfully maintained on long-term opioid therapy with no signs of aberrant behavior are best served by the planned speakers at this conference? Do we anticipate that unbiased, evidenced-based guidance will result from this event? Time will tell.