Oregon task force backs controversial opioid plan

An Oregon proposal to expand alternative treatments for certain chronic pain conditions while limiting the use of opioids has moved forward with minimal changes, despite outcries from chronic pain patients and criticism from pain experts across the country.

The Bulletin reports that the state's Chronic Pain Task Force, an ad hoc committee providing recommendations on treatments for chronic pain under Oregon's Medicaid program, backed a proposal Wednesday to provide coverage for five chronic pain conditions currently not covered by the Oregon Health Plan.

That would allow patients to receive services such as physical therapy, acupuncture and other types of treatment. Opioids would be covered in limited doses for some of the chronic pain conditions, but not for fibromyalgia or centralized pain syndrome, a central pain processing disorder that can heighten the response to painful stimuli.

The task force concluded that opioids are not beneficial and can be harmful for those conditions.

Overprescribing of prescription opioids has been blamed for the ongoing overdose epidemic nationwide.

Patients who are already taking doses above the opioid limits would be required to begin a taper of their medications at rate determined in conjunction with their doctor. Patients with fibromyalgia or centralized pain syndrome would be required to taper off opioids completely.

"This is basically more extreme and draconian than any approach in the country. It goes against all of the guidelines," said Kate Nicholson, a civil rights attorney from Colorado and a chronic pain advocate. "And importantly, it does so without regard for any attempt to measure potential harms or benefits to patients."

The proposal is the second try by the task force to craft the chronic pain coverage guidelines.

A previous proposal would have limited opioid coverage to 90 days and required patients to taper off painkillers within a year. After hearing from patients and providers, Oregon Health Authority staff reworked the proposal to soften the language and provide patients and their doctors more flexibility in the rate of tapering.

"We at OHA believe that health care delivery is really dependent on the trusting relationship between a patient and provider," Dr. Dana Hargunani, chief medical officer at OHA, told the task force. "All of the proposal elements, particularly addressing the opioid tapers . including the timelines, the rates and the ultimate success in getting to zero, are intended to be flexible and to meet individual patient needs based on the patient and doctor relationship."

Oregon Health Authority officials estimated that about 67,400 people would gain coverage to alternative pain treatments under the proposal and that between 600 to 1,200 patients would need to have their opioid treatments re-evaluated by their providers.