An Oregon committee has abandoned a controversial proposal that would have expanded treatment options for chronic pain patients under the Oregon Health Plan, but would have forced many to reduce dosages or discontinue prescription opioids.
The panel opted instead to wait for studies to be completed, delaying any potential change in coverage until at least 2022.
The decision derails the plan for forced tapers that drew nationwide criticism from pain experts and chronic pain patients.
But by rejecting the proposal, the five chronic pain conditions under consideration remain uncovered, leaving OHP patients with no guarantee of treatment.
The move confounded patients who had advocated for more than a year to maintain access to opioid treatment while expanding treatment options to include things like physical therapy, yoga, acupuncture or tai chi.
“The conditions being discussed are valid conditions, and I think they’re in need of medical treatment options. I think that opioids should be a part of those options,” said Wendy Sinclair, a chronic pain patient and co-founder of the Oregon Pain Action Group. “Doctors and patients need to work together and have those options available.”
Some patients with those conditions are receiving opioid treatment because they have other health conditions or because some of the coordinated care organizations that care for OHP members have opioids on their preferred list of drugs and don’t consider for what condition they are being prescribed.
The Health Evidence Review Commission determines what treatments are covered for what health conditions under the state’s Medicaid program through a prioritized list. State lawmakers then decide where in the prioritized list to draw the line between covered and uncovered services. Commission members decided there was not enough evidence to support the effectiveness of the types of treatments proposed, and to move treatments above the funding cut-off.
“Because the evidence supporting mostly the new treatment modalities wasn’t very high, it didn’t really move this line any higher into the funded region,” said Dr. Kevin Olson, an oncologist with the Providence Cancer Center in Portland and chairman of the commission.
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. A modified version considered by the commission in March still would have required patients with fibromyalgia, as well as those who didn’t meet a long list of criteria for ongoing opioid use, to taper completely off opioids.
Deliberations were paused in March, at the urging of the Oregon Health Authority, after a potential conflict of interest was raised regarding several individuals who had worked on the proposal. The agency then commissioned a third-party review to evaluate how closely the proposal aligned with the available evidence on chronic pain treatment, opioid use and tapering.
Based on that review, agency and commission leaders decided this week that new evidence regarding opioid therapy and tapering that became available in the past year warranted another look at the proposed changes.
“The past year has been a valuable learning experience for OHA and the HERC,” Olson said. “Not only will we apply what we learned to the chronic pain proposal currently under consideration, we feel there is enough new evidence to reopen the 2016 back pain guidelines to ensure our policies align with our best understanding of clinical evidence.”
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