In the 1990s, patient groups, academic journals, and the federal government urged health care providers to do more to address patients' pain — not just to reduce it, but also to eliminate it. Medical guidelines urged physicians to get patients as close to zero on the pain scale as possible.
Some big hospital systems, including the Veterans Health Administration, dubbed pain as the “fifth vital sign,” just as important as blood pressure and temperature. And, opioid medication came to market with promises of effectiveness with few side effects and little to no dependence.
In 2016, deaths due to drug overdose from opioids likely exceeded 59,000, the largest annual jump ever recorded in the U.S., according to preliminary data compiled by The New York Times. The number of deaths in 2015 was 33,091 
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Drug overdoses now exceed car crashes as the leading cause of unintentional death .
While the rate of opioid prescriptions has started to decline, it remains 56 percent higher than it was 20 years ago.
A key to preventing abuse is for patients to have an understanding of the risk factors associated with their medications. You can help promote this understanding by frankly discussing the risks, the realistic benefits of the medication, and expected length of treatment.
Most doctors voice their concerns:
The National Institute on Drug Abuse offers some guidelines for opioid prescriptions :
Treating acute pain with non-opioid medications may be an effective starting place. Research shows opioids are no more effective than non-opioid alternatives, like Tylenol or Advil, or the generic versions, at reducing acute pain.
“Opioid use has become an issue of national concern. While they can be effective in treating acute pain, there is mounting evidence that opioids are less than effective when used for chronic pain — and can actually do more harm than good,” said Norman Montalto, MD, a medical director with Highmark in West Virginia.
Some health systems now are providing behavioral and physical health treatments to minimize patients’ anxiety and reduce any delay in getting the treatment and other services they need. Without professional care coordination, many people drop out of treatment before attending follow-up appointments.
Many physicians now accept alternative or holistic medicine as a valid treatment option for pain. In fact, many alternative methods are standard practice at pain treatment centers.
Some of the most common alternative pain treatments are acupuncture, chiropractic manipulations, exercise, behavioral health therapy, relaxation therapy, hypnosis, biofeedback, massage, meditation, or yoga.
In addition to processing and paying pharmacy claims, prescription benefits managers (PBMs) may “flag” individuals who are suspected of abusing or misusing prescription medications. Some of the “flags” are:
PBMs may also track data on doctors who prescribe opioids, monitoring frequency, dosage, and length of therapy.
Many states also are using similar databases to track this information. In Pennsylvania, where the opioid death rate is above the national average, doctors now face sanctions if they don’t check the state database to verify if the individual has opioid prescriptions from multiple doctors. Please see the laws governing the Prescription Drug Monitoring Program for specifics.
In 2016, Highmark joined forces with axialHealthcare, a national leader in the appropriate use of opioids for pain management. Initiated in West Virginia, this partnership helps physicians better understand their patients’ total prescription and medication use and gain insight into their own prescribing patterns.
For more information about axialHealthcare, please see future editions of Provider News.
