The Joint Commission is defending its requirement that healthcare providers assess and treat pain. The standards have come under fire as playing a role in the rise of prescription painkiller abuse over the past decade.
The nation's largest healthcare accreditation organization on Tuesday clarified that its standards for pain management and treatment, which were established in 2001 to address the undertreatment of pain, do not require or specify the use of opioids or any type of drugs.
“In the environment of today's prescription opioid epidemic, everyone is looking for someone to blame,” Dr. David Baker, the Joint Commission's executive vice president of healthcare quality evaluation, said in a written statement. “Often, the Joint Commission's pain standards take that blame—we are encouraging our critics to look at our exact standards, along with the historical context of our standards, to fully understand what our accredited organizations are required to do with regard to pain.”
The statement came in response to an April letter to Joint Commission CEO Dr. Mark Chassin (PDF) signed by a number of leaders of state health departments, professional medical organizations and patient advocacy groups requesting the commission reconsider the standards.
“The pain-management standards foster dangerous pain control practices, the endpoint of which is often the inappropriate provision of opioids with disastrous adverse consequences for individuals, families and communities,” the letter stated. “To help stem the opioid addiction epidemic, we request that TJC re-examine these standards immediately.”
The group also sent a petition to acting CMS Administrator Andrew Slavitt requesting the agency remove questions about pain treatment from the Hospital Consumer Assessment of Healthcare Providers and Systems survey, which measures a patient's experience during a hospital stay based on 27 categories. The results are a significant factor in Medicare's Value-Based Purchasing program, which critics say implicitly encourages providers to overprescribe pain relievers to avoid financial penalties.
Sales of prescription opioids in the U.S. nearly quadrupled between 1999 and 2014, according to the Centers for Disease Control and Prevention. The agency estimates providers wrote 259 million prescriptions for painkillers in 2012. Over the last decade there has been a stark rise in overdose deaths related to the use of prescription opioid medications. In 2014, 61% of the more than 47,000 overdose deaths that occurred that year were related to some form of opioid, including heroin.
The Joint Commission said prescribing rates were on the rise for years before it rolled out its pain-management standards.
Baker said the criticism of its standards is based on a number of “misconceptions,” including that they call for pain to be treated as a vital sign.
Dr. Andrew Kolodny, executive director of Physicians for Responsible Opioid Prescribing and a co-signer of the letter and petition, acknowledges the Joint Commission was not the cause for the current opioid addiction epidemic, agreeing that the trend began years before the release of the standards.
But Kolodny does contend that the Joint Commission played a role in a campaign aligned with drug companies to increase opioid prescribing, which he says contributed to overuse.
“When the Joint Commission released its standards, it distributed educational materials developed by Purdue Pharma that minimized opioid risks, especially the risk of addiction, and exaggerated benefits of opioids, “ Kolodny said in an e-mail. “TJC is no longer distributing these materials, but they have yet to acknowledge their role in the campaign to increase opioid prescribing. In short, there is much more that TJC needs to do to reduce the aggressive use of opioids that it helped promote. A significant revision to the pain standards would be a very good place to start.”