CMS opioid strategy could keep palliative care patients from receiving therapy, expert says

A plan released by the Centers for Medicare & Medicaid Services to combat opioid abuse could end up harming patients who require the drugs for end-of-life-care, according to one expert.

CMS' Opioid Misuse Strategy, released in January, includes four priority areas to tackle the opioid epidemic:

  • Implementing more effective strategies to reduce risk of opioid use disorders, overdoses, inappropriate prescribing and drug diversion
  • Expanding the use of naxolone, a drug to treat narcotic overdoses
  • Expanding screening, diagnosis and treatment of opioid use disorders
  • Increasing evidence-based practices for acute and chronic pain management

Bob Twillman, Ph.D., executive director of the Academy of Integrative Pain Management, told Managed Health Care Connect last week that the strategy to curb inappropriate prescribing may cause concern among providers.

“The challenge is not so much in reducing opioid prescribing, but in coming up with other effective treatments for patients who still experience pain after their opioids are taken away,” Twillman said. “CMS could help us tremendously by increasing coverage for non-pharmacological treatments under Medicare and Medicaid.”

A daily dosage limit of 90 morphine milligram equivalents per day proposed as part of CMS' strategy should also receive more scrutiny, Twillman said, since the level may not be sufficient for every patient.

“There are some patients with chronic pain, even pain unrelated to cancer or associated with palliative or end-of-life care, who need opioids to achieve the best possible outcomes,” he said. “I‘m concerned that CMS's proposal will result in some patients being unable to get the therapy they need.”

Twillman pushed provider education as a top priority in the fight against opioid abuse, as well as better reimbursement and access for non-pharmacological treatment methods.

“We need to have prescribers and pharmacists approach and educate policymakers about the reasons we've gotten to where we are, and about what they can do to help us provide better patient care,” Twillman said.