Much of the blame for the country’s opiate-fueled overdose crisis has been aimed at the pharmaceutical industry. Abetted by aggressive salesmen and doctors receiving kickbacks, “Big Pharma” flooded places like West Virginia with hundreds of millions of prescription pain pills, hooking tens of thousands of people and paving the way for subsequent waves of heroin and, finally, potent and deadly fentanyl.
It’s a compelling narrative — the timeline is neat and there’s a convenient villain. But it absolves another another accomplice whose dirty work is continuing unabated: the health insurance industry.
Few decisions in healthcare are made without insurers’ involvement. And, according to a ProPublica/New York Times investigation, insurers are discouraging doctors from writing prescriptions for cheaper, less-addictive painkillers, and instead encouraging the prescription of opiates.
The news organizations took a look at nearly 36 million prescription drug plans offered under Medicare, the single-payer health plan available to Americans 65 and older and to younger Americans with disabilities. More than 55 million Americans are covered by Medicare.
Medicare pays for coverage provided by as many as 50 private health insurance companies, some of which dole out opiates with ease and makes patients work harder for less-addictive options.
From the Times:
Only one-third of the people covered, for example, had any access to Butrans, a painkilling skin patch that contains a less-risky opioid, buprenorphine. And every drug plan that covered lidocaine patches, which are not addictive but cost more than other generic pain drugs, required that patients get prior approval for them. In contrast, almost every plan covered common opioids and very few required any prior approval.
Health insurance companies insisted to the Times that they’re trying to reduce reliance on opioids, all of which are “addictive,” according to a spokesman from UnitedHealthcare, the country’s largest insurer.
Whether it was doctors’ fault or insurers’ fault or pharmaceutical companies’ fault, patients continue to receive opiate prescriptions despite the massive risks — and despite the fact that they don’t work very well.
Opiates have only “unproven and transient benefits” for sufferers of chronic pain like arthritis and back pain, according to The Centers for Disease Control and Prevention. According to a study released earlier this year, opiates are less effective at treating pain than non-pharmaceutical treatments like massage and exercise. In some cases, relying on opiates only makes the underlying pain worse.
The problem is, most insurance companies don’t cover massage, nor do they cover therapeutic exercise like yoga. But they do cover opiates — and so that’s what patients receive.
What changes insurers have made include drastically cutting the supply of opiates given to patients, and making it easier to access drugs that treat addiction. You see the problem here: Opiates are still part of the equation. And they’re the problem.
Pharmaceuticals companies’ motives aren’t exactly clear. For instance, Purdue Pharma manufactures both OxyContin and Butrans. Butrans is more expensive — and yet insurers still directed patients to cheaper and more dangerous OxyContin.
The irony here is that patients have also been blamed for their own addictions — for engaging in what experts call “drug-seeking behavior.” On the contrary: many patients have been engaging in drug-avoidance behavior, lobbying their insurers to cover a preferred alternative to opiates.
But that bureaucratic process is lengthy. Add in the bare fact that the patient is in pain, and many simply give up and take the opiates. Or live in pain.
It bears mentioning that a majority of American scientists believe in cannabis’s ability to soothe chronic pain.
In January, the National Academies of Sciences, Engineering, and Medicine released a landmark report that found “evidence to support that patients who were treated with cannabis or cannabinoids were more likely to experience a significant reduction in pain symptoms.” Studies have also shown where cannabis is available, deaths from opiate overdoses drop by as much as a third.
It’s too much to declare that marijuana by itself will solve the opiate crisis, but it could help — though not nearly as much as stopping the flow of pharmaceuticals, a flood that insurance providers keep moving.
TELL US, have you found pain relief from cannabis?