An article circulated by Kaiser Health News this week shows just how hard the battle to fight opioids really is. Even when you do away with them altogether and offer viable, natural, cost-effective, nonaddictive alternatives.
By way of a different approach, Missouri began offering chiropractic care, acupuncture, physical therapy and cognitive-behavioral therapy for Medicaid patients starting last April.
Yet only about 500 of the state’s roughly 330,000 adult Medicaid users accessed the program through December, at a cost of $190,000, according to Josh Moore, the Missouri Medicaid pharmacy director. While the numbers may reflect an undercount because of lags in submitting claims, the jointly funded federal-state program known in the state as MO HealthNet is hitting just a fraction of possible patients so far.
Meanwhile, according to Missouri health officials, opioids were still being doled out: 109,610 Missouri Medicaid patients of all age groups received opioid prescriptions last year.
The problem? Americans apparently have no tolerance for pain. We truly seem to seek instant relief or gratification.
The going has been slow, health experts said, because of a slew of barriers. Such treatments are more time-consuming and involved than simply getting a prescription. A limited number of providers offer alternative treatment options, especially to Medicaid patients. And perhaps the biggest problem? These therapies don’t seem to work for everyone.
The slow roll-out highlights the overall challenges in implementing programs aimed at righting the ship on opioid abuse in Missouri — and nationwide. To be sure, from 2012 to 2019, the number of Missouri Medicaid patients prescribed opioid drugs fell by more than a third — and the quantity of opioids dispensed by Medicaid dropped by more than half, Kaiser Health News reported.
Still, opioid overdoses killed an estimated 1,132 Missourians in 2018 and 46,802 Americans nationally, according to the latest data available. Progress to change that can be frustratingly slow.
Despite limited data on the efficacy of alternative pain management plans, such efforts have become more accepted, especially following a summer report of pain management best practices from the U.S. Department of Health and Human Services. States such as Ohio and Oregon see them as one part of a menu of options aimed at curbing the opioid crisis.
Vermont has been desperate to move in the same direction.
While Missouri health-care providers now have another tool besides prescribing opioids to patients with Medicaid, the multistep approaches required by alternative treatments create many more hoops than a pharmacy visit. And that is proving just as elusive in the search for a real solution.
The physicians who recommend such treatments must support the option, and patients must agree. Then the patient must be able to find a provider who accepts Medicaid, get to the provider’s office even if far away and then undergo multiple, time-consuming therapies.
The effort and cost that go into coordinating a care plan with multiple alternative pain therapies is another barrier.
And then there’s the reimbursement issue for the providers. Corry Meyers, an acupuncturist in suburban St. Louis, told Kaiser Health News he does not accept insurance in his practice. But he said other acupuncturists in Missouri debate whether to take advantage of the new Medicaid program, concerned the payment rates to providers will be too low to be worthwhile.
Here in Vermont, we are also aware of the root of the problem: Opioid overutilization or overprescribing is not just a crisis in and of itself; it’s a symptom of broader structural problems in the U.S. health-care system. Prescribers reach for opioids in larger numbers not just because they were being fooled into doing so by pharmaceutical companies, but because they work well for a variety of ailments.
Fixing some of the core problems leading to opioid dependence — rural health care “deserts,” and the impact of manual labor and obesity on chronic pain — requires much more than a treatment alternative, Kaiser Health News points out. And no matter how many alternatives are offered, opioids likely will remain a crucial medicine for some patients.
Overall, it seems like a step in the right direction. Maybe in a smaller state, one that already has marked successes with naturopathic and homeopathic treatments, and has boldly embraced CBD and other treatments, the results would be more noticeable, at least per capita.
Might be worth a try. It could prove to be a powerful first for Vermont in a long list of firsts.