Oregon health officials have delayed consideration of a controversial change under the Oregon Health Plan that could have forced many patients with chronic pain off opioids. While chronic-pain patients cheered the development as a sign the agency wanted to back off the proposal, early indications suggest the delay may be more of a speed bump than a stop sign.
The proposal was scheduled to be considered by the Health Evidence Review Commission Thursday. But Oregon Health Authority director Patrick Allen asked for more time to allow the agency to review a potential conflict of interest that arose with a consultant who had worked on the proposal.
The agency received a letter from Amara Moon, a chronic-pain patient in Oregon who has been organizing opposition to the proposal. Moon asked whether any voting members of the commission were involved in a study of an earlier policy approved by the commission requiring tapering of lower back pain patients.
A subsequent staff review identified a potential issue involving Dr. Catherine Livingston, a pain expert with Oregon Health & Science University in Portland, who had not disclosed to the agency grant funding related to the study.
Livingston serves as the associate medical director for the commission and in that role helped to write the proposal under consideration.
“It’s not completely certain that this is necessarily a conflict of interest,” Allen said. “She’s a contractor and not an employee, and the nature of the compensation, the nature of the research, I think we generally know, but we probably need more details.”
Allen said contractors and commission members fill out financial interest disclosure forms that the agency reviews to prevent conflicts of interest. Livingston did not respond to request for a comment.
Chiropractor Vern Saboe, a member of a subcommittee reviewing the proposal, and acupuncturist Laura Ocker, who served on the Chronic Pain Task Force that developed it, are consultants to the study in question. A agency spokeswoman could not confirm whether they had been paid for the role.
The proposal under consideration would establish new coverage under the Oregon Health Plan for five chronic pain conditions that have not been covered in the past. That would allow patients with those conditions to receive opioid and non-opioid medications, as well as a range of non-pharmacological services, such as physical therapy, yoga or acupuncture to help them manage their pain.
But the proposed policy has been mired in controversy over initial language that would have forced patients with those conditions to be tapered off of opioids within a year. After public outcry and input from pain experts, the task force modified the language to allow some patients to remain on opioids longer. But the final version would still require patients with fibromyalgia or back pain, as well as those who didn’t meet a long list of criteria for ongoing opioid use, to taper completely off opioids.
The proposal has drawn national attention as chronic-pain patients and pain experts fear it could set a precedent for other public and private health plans to cut people off pain medications.
More than 100 pain experts signed a letter to the agency urging it to delay consideration until new studies, expected to be published within the year, could determine the impact of tapering on patients.
Many took it as a sign that state officials and commission members had soured on the plan or at least were willing to reconsider the evidence. But Allen said the pause was more of “a process issue” and that he anticipated the conflict of interest review could be completed within a few days.
The delay throws the timing of the change into question, as changes in OHP coverage are done through biennial reviews. The March meeting of the commission was initially described as the last chance to approve the policy in time for a 2020 implementation. If the commission opted to delay consideration and wait for more evidence, the process wouldn’t be completed until 2022.
But Allen said the agency had some flexibility in the timeline. Agency staff is working to schedule an interim meeting of a subcommittee and the full commission before the next scheduled meeting in May.
“I really don’t anticipate this extending into the next biennial review,” he said.
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