CMS

Many patients with chronic pain are concerned about the unintended consequences of the Centers for Medicare and Medicaid Services’ (CMS) newly published proposal to curb opioid misuse and abuse, “Opioid Misuse Strategy 2016.” U.S. Pain urges the pain community to email CMS by Friday, March 3, to ask them to reconsider several proposed changes that could harm people living with chronic pain.

“While U.S. Pain supports measures that will improve the treatment of people living with opioid use disorders, the foundation is disappointed that CMS’s proposed strategy does not give fair consideration to the millions of Americans who live with debilitating chronic pain and will likely cause needless suffering,” says Cindy Steinberg, national director of policy and advocacy for U.S. Pain.

“Even if you are not on Medicare or Medicaid, it is crucial that we all take action on this issue,” says Steinberg. “First, Medicare and Medicaid patients with pain are among the most vulnerable populations of patients. They are elderly, disabled, or impoverished, and may already have to fight for proper access to care. Furthermore, the policies implemented by CMS often guide the actions of private insurers, who frequently adopt policies after CMS does.”

Below you will find a sample email message to send to CMS by March 3. Comments should be emailed to: AdvanceNotice2018@cms.hhs.gov. A final version of the strategy will be published on April 3, 2017. You can also click here to send a generic version of the email after entering address information.

To whom it may concern,

I am writing to you as a chronic pain patient and member of the U.S. Pain Foundation who is deeply concerned about certain provisions in CMS’s Opioid Misuse Strategy.  [Explain here what type of pain you have and how it affects you.]

As the leading chronic pain patient advocacy group, U.S. Pain Foundation is committed to protecting access to vital pain management options and preventing pain medication abuse. We believe it is possible to achieve both goals through balanced reform. Unfortunately, many recently adopted policies at the federal and state level are causing unnecessary suffering for patients with pain. We believe aspects of the CMS’s Opioid Misuse Strategy will further harm patients with legitimate pain and urge you to reconsider them.

We support CMS’s priority areas two and three, which we are important steps to reducing opioid misuse and abuse. However, we urge CMS to reconsider certain aspects of priority areas one and four (“Implement more effective person-centered and population-based strategies to reduce the risk of opioid use disorders, overdoses, inappropriate prescribing, and drug diversion” and “Increase the use of evidence-based practices for acute and chronic pain management” respectively).

In addition to three specific concerns detailed below, our general worry is that many of the measures in priority areas one and four—however well-intentioned—will have a chilling effect on pain care, which in many ways, is already under siege. [Explain here how opioid limitations may have affected you.]

There are four specific measures in these two areas that we find distressing:

  1. Revoking prescribers’ enrollment in Medicare Part D for “inappropriate behavior.”Threatening prescribers with revoking participation in Medicare Part D is an extreme measure. It seems more directed at frightening care providers into not prescribing or, worse, not treating chronic pain patients than it does encouraging compassionate, patient-centered care for our sickest, oldest and most vulnerable population of Americans. Who will judge what is “inappropriate behavior” and what measures will be provided by CMS to allow prescribers to appeal such an extreme sanction?
  2. The dosage limit of 90 mg of morphine equivalent milligrams a day.We believe that medication dosage is best left to clinicians, who are explicitly trained to administer medications in a way that meets their patients’ unique needs. It is crucial to understand that each patient is different. The type and amount of medication administered depends on patients’ unique body chemistry, their size and weight, and the specifics and severity of their pain. While 90 mg may be too much for one patient, for another, it might be the only way to manage their pain and allow them any semblance of daily function.It is important to understand that the Centers for Disease Control and Prevention’s opioid guidelines were created as just that—guidelines, not rules. The guidelines also are explicitly intended for primary care providers, not specialists who may be treatment patients with extremely complicated, debilitating pain conditions. A direct quote from the CDC: “The guideline provides recommendations for primary care providers who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care and end-of-life-care;” [Emphasis added.] CMS’s proposed change ignores this vital context.
  3. Monitoring and tracking measures that pit pharmacists, physicians, and patients against one another and publishing individual prescribers’ opioid prescribing rates.We are concerned this will create a negative environment that is counterproductive to the collaboration and patient-provider relationship required for effective, high-quality health care. Because of the current backlash against opioids, many clinicians already are afraid to prescribe them—even when they are necessary and appropriate for a patient’s pain management. Threatening doctors with punitive measures even when prescribing appropriately is leading to unintentional and unnecessary patient suffering.
  4. The lack of specific measures to ensure nonpharmacological treatments are accessible and affordable.U. S. Pain enthusiastically supports the call for an increased focus on alternative, nonpharmacological treatments, such as physical therapy, cognitive behavioral therapy, massage, and chiropractic care, as well as on non-opioid pharmacological treatments. However, in most cases, these alternative, nonpharmacological treatments are not well-covered by insurance, if they are covered at all. CMS is not specific about what it will do to ensure that these alternative treatment modalities will be covered and payers that work in conjunction with CMS. It is unfair to severely limit opioid medications for legitimate pain patients without presenting a tangible plan for increasing the accessibility of effective alternatives.

Controlling the misuse and abuse of pain medications is critical, but the importance of decreasing substance use disorder does not outweigh the needs of millions of people who suffer from debilitating chronic pain. On behalf of pain patients everywhere, please reconsider these measures and the negative impact they will have.

Sincerely,

[Your name]

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