Many pain specialists and patients with chronic pain are concerned about the proposed limits on opioid prescriptions that are to take effect in January 2019 for those covered by the Centers for Medicare & Medicaid Services (CMS).
A big concern is that current patients already on long-term opioid therapy might be suddenly cut off, or that their insurance or Medicaid/Medicare will no longer cover their prescriptions.
Potential risks are that these people could turn to more dangerous formulations or even illegal street drugs if they cannot be medically tapered by a competent pain specialist who will also help them find a treatment plan that allows them to function and have good quality of life.
An article in the New York Times on March 28, 2018, quoted Erin E. Krebs, MD, MPH, who has authored studies concluded that opioids were no better than nonopioid painkillers at treating certain types of pain. Krebs is an associate professor of medicine at University of Minnesota and a core investigator with the Center for Chronic Disease Outcomes Research in the US Department of Veterans Affairs.1
In March, the Journal of the American Medical Association published Krebs' latest study,2 which concluded that opioids were no better-and sometimes not as good as-acetaminophen and other nonnarcotic painkillers for chronic back pain, or hip or knee pain caused by osteoarthritis.
She also was on the "Core Expert Group" that in 2015 drafted opioid-prescribing guidelines for the US Centers for Disease Control and Prevention (CDC). She is generally seen as a researcher who has been against the use of opioids for chronic pain.
Nonetheless, Krebs and others who worked on the CDC guidelines signed a letter to the CMS opposing the Medicare rule.
"My concern is that our results could be used to justify aggressive tapering or immediate discontinuation in patients, and that could harm people-even if opioids have no benefit for their pain," Krebs told to the New York Times.1
"Even if we walk away from using opioids for back and knee pain, we can't walk away from patients who have been treated with opioids for years or even decades now," Krebs added. "We have created a double tragedy for these people."
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