Oregon is considering stopping coverage for opioid painkillers for people with chronic pain who use the state's Medicaid plans, STAT News reports. Officials hope to curb overdoses that they think are caused by the overprescription of such drugs to chronic pain patients, Dana Hargunani, chief medical officer for the Oregon Health Authority, told STAT.
If the plan passes, Oregon would be the first state to take this step. The proposal is a sign of how quickly medical and political opinion have turned against opioids. Just two years ago, a Centers for Disease Control and Prevention guideline suggesting that doctors consider capping the opioid dosage they prescribe for people with chronic pain was considered controversial.
Meanwhile, the science hasn't been able to keep up. There's little research examining what might happen if a large population of chronic pain patients is forced to taper off of opioid prescriptions, as STAT notes. One recent systematic review found that reducing or stopping people's long-term opioid prescriptions might actually help them with their pain and improve their quality of life—but the evidence for that was "very low quality," the review's authors write. At the same time, there was "insufficient evidence" about the possible drawbacks of tapering. Many chronic pain patients have written op-eds or told reporters that, without their prescriptions, they may become suicidal or seek out street drugs to treat their pain.
"Public health surveillance and large-scale observational studies are needed to assess outcomes of efforts to reduce opioid prescribing at the health system and population levels," the review's authors write, "especially rare but important adverse events, such as overdose and suicide."