By Dede Sweeney, ONS Director of Government Affairs
The Department of Health and Human Services (HHS) Pain Management Best Practices Inter-Agency Task Force held its first public meeting from May 30–31, 2018, in Washington, DC.
Convened as part of 2016’s Comprehensive Addiction and Recovery Act, the task force was charged to address the nation’s continued opioid abuse crisis. During the two-day meeting, the 28-member task force deliberated on the goals of an upcoming study, set to be released July 2019, that aims to update best practices and clinical guidelines, while also addressing gaps and inconsistencies in chronic and acute pain management.
Several federal health officials, including HHS Secretary Alex Azar, offered presentations to the task force, noting that a lack of quality pain management along with the ease of inexpensive prescription pills has led to overprescribing in the United States at a rate four times that found in European countries. The U.S. Food and Drug Administration Commissioner, Scott Gottlieb, also shared concerns with providers regarding the opioid over-prescription, expressing his support for dosage controls such as blister packs and less addictive alternatives. The task force’s Chair, Vanila Singh, MD, MACM, chief medical officer at the HHS, urged her fellow task force members to strike the right balance between addressing the opioid crisis and avoiding harm to patients who depend on pain medications for acute and chronic illnesses—including patients with cancer.
Understanding the Patient’s Perspective
Several patients with acute and chronic pain spoke to the task force, sharing the challenges they face obtaining proper pain medications to manage their illnesses because of new opioid prescribing restrictions and recent pushback from both insurers and providers. One patient with a severe degenerative spinal disease described being made to feel like a criminal rather than a patient when requesting opioids. Patients also shared the central role opioids play when helping them with daily function and quality of life.
During public comments, several individuals asked the panel not to conflate patients with chronic pain—like many of those with cancer—with individuals exhibiting substance abuse disorders. Some patients argued that fentanyl and heroin are more of a crisis than opioids.
The Task Force’s Key Takeaways
Several common themes emerged over the task force’s two-day meeting, including the need for improved education for primary care providers and patients regarding how to manage pain, taper dosages, and when to respond with medication-assisted treatment for patients with substance abuse disorder. The task force also discussed involving interprofessional resources like pain specialists to prevent addiction in younger patients receiving opioids for wisdom teeth surgeries and sports injuries. A representative from the Department of Veterans Affairs also shared how the agency has successfully reduced opioid prescriptions to veterans with the educational initiative, “Bust the Myth That Pain = Opioids.”
Some panelists went so far as to criticize our culture’s obsession with being pain free, stating that the pain scale may create arbitrary pain levels that could result in overprescribing. Several physicians also commented that the typical 12–15-minute office visit may not offer sufficient time to truly uncover pain needs and addiction issues. As a solution to the issue, panelists supported multimodality treatments and opioid alternatives. Yet, many practitioners expressed frustrations that opioid alternatives often come with higher copays or a total lack insurance coverage.
In comments previously submitted to the HHS pain task force, ONS expressed disappointment that only one nurse was represented on the physician-dominated panel, especially considering the nurse’s role in symptom assessment and pain management.
Bruce Schoenboom, PhD, CRNA, FAAN, chief learning officer at the American Association of Nurse Anesthetists and the sole nurse on the panel, urged the task force to leverage the expertise of the nation’s two million nurses and APRNs who already provide care for patient in pain in communities throughout the country. Schoenboom also noted that opioid abuse could be avoided if patients were treated by local nurses, limiting long travel distances for pain management.