The Opioid Crisis: What is the Government Doing About It? Part 3 – The Promotion of Healthy, Evidence-Based Methods of Pain Management

Medicare Set-Aside Blog, MSP News, Rx/Pharmacy on November 2, 2018
Posted by Complex Claims Division

This blog series is devoted to better understanding the efforts our Federal government is undertaking to combat the opioid epidemic in America. Earlier this year, the Department of Health and Human Services (HHS) announced a five-part strategy that will be utilized to combat the opioid epidemic. In previous posts, we have focused on parts one and two of the strategy which include (1) increasing availability to addiction treatment services and (2) improvements in public health data and reporting as a means to drive more effective solutions for the ever-expanding opioid crisis.

In this post, we’ll examine the third prong of HHS’ five-part strategy, which is the promotion of healthy, evidence-based methods of pain management. The Comprehensive Addiction and Recovery Act of 2016 was the genesis for the Pain Management Best Practices Inter-Agency Task Force. The Task Force is a large group comprised of Federal representatives from various HHS agencies, the Department of Veterans Affairs, the Department of Defense (DOD) and the Office of National Drug Control Policy. Non-Federal representatives include experts from various health care disciplines (e.g. pain management, substance use disorders, mental health and others) as well as patients, members of advocacy groups and first responders to overdose situations. The Task Force has been charged with two responsibilities: (i) to determine whether there are gaps or inconsistencies in pain management best practices among federal agencies; and (ii) to propose recommendations for the best ways to address identified gaps or inconsistencies.

While this is undoubtedly a good idea, it’s not a new idea. In 2010, the Patient Protection and Affordable Care Act required HHS to partner with the Institute of Medicine (IOM) on a very similar initiative. The goals for the HHS-IOM partnership were to (i) increase awareness of pain as a significant public health problem; (ii) identify and reduce barriers to appropriate care; (iii) evaluate the adequacy of assessment, diagnosis, treatment and management of acute and chronic pain across the population; and (iv) improve pain care research, education and care. The result of the partnership was a report issued by the IOM in 2011. The report included 16 recommendations for improvements in data collection and reporting; the availability and effectiveness of pain care; public, patient and professional education about pain; and relevant basic, translational and clinical research.  There is seemingly a great deal of overlap between the recommendations that resulted from the HHS-IOM partnership in 2011 and HHS’ current five-part strategy . . . and this begs the question, “Did these previous efforts fail and if so, why?”

This is not the only Federal initiative underway to develop best practices for the treatment of pain. The National Institutes of Health (NIH) has designated eleven academic centers across the United States as Centers of Excellence in Pain Education. These centers serve as a resource for students of many health care disciplines to enhance knowledge of pain and its treatment. Last year, the Veterans Administration, DOD and NIH announced a collaborative research project which will devote $81 million over six years to support pain management research in military and veteran populations.  The Indian Health Service has created a national committee on Heroin, Opioid and Pain Efforts (HOPE) which will focus efforts on safe, effective pain management and the prevention of opioid misuse.

Last but certainly not least, the Food and Drug Administration (FDA) is constantly surveilling the opioid landscape to identify those agents whose risks outweigh its benefits. As outlined in our prior blog posts, on June 2017, the FDA recommended that Opana ER be withdrawn from the market for these reasons. In July 2018, the manufacturer of Opana ER, Endo Pharmaceuticals, complied and withdrew Opana ER from the market.