All doctors swear the Hippocratic Oath. Often summarized as a command to “first do no harm,” the promise also underscores the need for sympathy throughout a patient’s care. As simple as it sounds, abiding by this commitment when treating patients in pain can be complicated.
With the opioid epidemic raging through our communities, it’s no secret that some cases of addiction originated in health care settings. For years, patients who needed a wisdom tooth removed were sent home with a bottle of oxycodone. Surgery to repair a broken back would be followed by weeks of powerful narcotic painkillers. Doctors prescribed opioids, which we were assured were safe, in order to keep patients from suffering.
I will leave aside the marketing abuses that contributed to an opioid-dominated pain management protocol. Fortunately, the medical community has since refined prescribing practices, and I congratulate those who have steered positive change.
Advanced studies in post-operative pain from dental surgery, for example, have shown that a combination of non-narcotic drugs can supply comparable pain relief to that of opioids. Practitioners such as myself are using even over-the-counter anti-inflammatory medications with great success.
Nonetheless, there remain cases when such pain management strategies are not sufficient, and practitioners’ empathy and protective impulses can conflict. We cannot ethically decline to treat pain, and this is how nine out of 10 surgery patients came to receive a prescription for an opioid painkiller.
The good news is that those days are ending. Promising research has resulted in a new class of non-opioid pain therapies, which have been approved by the U.S. Food and Drug Administration for the treatment of post-surgical pain. These non-opioid medications can be injected by the physician to provide effective, long-lasting pain relief.
In some circumstances, this therapy will fully eliminate the need for opioids. When there is residual pain, patients need far fewer opioid doses to find comfort and recover.
Needless to say, it is in the nation’s best interest to make non-opioid alternative pain therapies widely available. There are, however, barriers to patient access to these medications. Among them is a payment rule in Medicare, which inadvertently incentivizes the continued use of opioids for pain management after some forms of surgery.
The obvious answer is to modernize Medicare policy to correspond with developments in the field of medicine. To be fair, the Medicare agency did so with regards to surgeries after which a hospital stay is required.
But policymakers failed to address the much larger number of outpatient surgeries taking place each year. This means many of our parents and grandparents and our disabled friends and neighbors are being treated with unnecessary quantities of opioids.
We should not make the unfortunately common mistake of assuming Medicare patients are not at risk of addiction if they aren’t seeking a “high.” Physical opioid dependence is a complex condition and can develop at any age and at any dosage level. Extended or repeated exposure to opioids — as can occur in people with multiple health problems — increases risk. Addiction among the Medicare-age population is, in fact, rising, and the U.S. must use every means possible to reverse this trend.
There is also the issue of opioids in our communities. Literally billions of opioid pills are sent home with surgery patients every year. A mere 10 percent reduction in surgery-related opioid prescribing could keep 332 million opioid pills out of Americans’ medicine cabinets.
That means fewer prescription painkillers for the patient to misuse, fewer doses available for abuse by friends or family with access to the home, and fewer drugs stolen and sold on our streets.
A final reason to support a Medicare update, federal policy often sets the standard for the entire health care system. If surgeons are encouraged to use non-opioid pain therapies for Medicare patients, most will adopt the prescribing habit for patients with other insurance coverage as well.
Few medications are cheaper than opioids, which cost only pennies per pill. But by investing a bit more in safer post-operative pain management therapies, the U.S. can increase quality of care, operate with basic compassion for those suffering in pain, and contain long-term spending on addiction treatment and the many physical and societal impacts of the opioid epidemic.
From the perspective of an experienced health care provider, Medicare coverage of non-opioid pain therapies after surgery is the wisest course of action. Congress should pass legislation to make it happen.
Dr. Brice Arndt has been practicing dentistry in Pennsylvania for more than 30 years. He is also a cofounder of the Foundation for Surgical Excellence and serves on the PA Dental Association’s Government Relations Committee.