Thursday, March 29, 2018

Blue Cross and Blue Shield advises acetaminophen or ibuprofen for primary pain treatment instead of opioids

The Blue Cross and Blue Shield Association now recommends using acetaminophen or ibuprofen instead of opioids as the first or second choice for managing pain. Opioids may be best for things like cancer treatment or palliative care, but "in most cases, ibuprofen and acetaminophen can treat pain more effectively than opioids, said Dr. Trent Haywood, chief medical officer for Blue Cross, which has about 106 million members," Alex Kacik reports for Modern Healthcare. "It's important that physicians understand that alternatives like medication-assisted treatment exist, which pairs medication with behavioral counseling, he said."

According to its internal analysis, 21 percent of the Blues' commercially insured members filled at least one opioid prescription in 2015, and the number of Blue members with an opioid-use disorder diagnoses increased 493 percent from 2010 to 2016.

Haywood says opioids are half as effective as over-the-counter pain medications, but two to four times more harmful. Doctors may not be aware of that, partly because of misleading marketing campaigns by pharmaceutical companies. In 2007 Oxycontin maker Purdue Pharma reached a $635 million settlement with the federal government over claims that Purdue downplayed the addictive nature of the drug. Several states and tribes have filed similar claims against several drug firms.

Another possible reason doctors prescribe opioids so much is that they, and hospitals, used to get performance incentives based on how much pain their patients reported. And there may be a more sinister reason: An analysis by CNN and Harvard University found that doctors who prescribe more opioids get speaking or consulting fees from drug manufacturers.

Insurers, pharmacies, distributors and providers have restricted the number and size of opioid prescriptions they give out, "but physicians worry that reducing the supply could cut off access to patients who need the potent drugs," Kacik reports. "Also, insurers have been slow to cover alternatives to opioids. Prior authorization for medication-assisted treatment is another big roadblock."

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