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HHS Inter-Agency Task Force Urges New Ways to Limit Opioid Use and Addiction

January 3, 2019
The proposed recommendations will be submitted to Congress in 2019.

A PPM Brief (Updated February 21, 2019)

The Pain Management Best Practices Inter-Agency Task Force has released a new draft report,1 taking a look at opioid exposure and addiction. The task force has stressed the need for changes in the treatment of opioid-addicted patients, including a call for efforts to address the stigma surrounding substance abuse. The draft report urged “consistent and timely insurance coverage” for interventional procedures early in pain treatment, while also calling for the establishment of criteria-based guidelines for credentialing properly trained physicians.

Source: 123RF

Other noteworthy recommendations outlined in the draft include:

  • The use of multidisciplinary approaches for perioperative pain control, such as preoperative psychology, screening and monitoring, and planning for managing pain of moderate to severe complexity.
  • Urging the Centers for Medicare & Medicaid Services (CMS) and other insurers to align their reimbursement guidelines for nonopioid pharmacologic therapies with current clinical practice guidelines.
  • The consideration of acupuncture, mindfulness, movement therapy, art therapy, massage therapy, manipulative therapy, yoga, and Tai Chi as non-opioid treatment options.
  • Conducting more research on complementary approaches to determine value, risk and benefits, mechanisms of action, and economic contributions.
  • Countering stigma that “equates pain with weakness” through public relation campaigns, encouraging early treatment for persistent pain.
  • Addressing the perceived racial bias seen with treatment of pain for people with sickle cell disease.

Of note, the task force looked at numerous influencers on the physician side that may have impacted the current opioid climate, including:

  • The aggressive marketing of newer opioid products at a time of limited coverage for other pain management options.
  • The demand for electronic health records (EHRs) to lower pain scores, which may have increased physician burnout and lowered the ability of physicians to focus and care for the complexities of pain.
  • The unintended consequences of policies such as those from state monitored programs, which may have caused some clinicians to refuse to provide prescriptions for patients on a stable regimen. As a result, desperate patients may have turned to illicit drugs such as fentanyl and heroin.

The Comprehensive Addiction and Recovery Act of 2016 called for the establishment of this 29-member task force, including federal officials and pain experts from both academia and private practice. Overseen by HHS and the departments of Veterans Affairs and Defense, the task force intends to submit a final set of recommendations to Congress after receiving public comments through April 1, 2019.

 

Managing Pain During the Opioid Crisis - A Senate Hearing

In related news, pain patients everywhere rejoiced when Cindy Steinberg, National Director of Policy and Advocacy for the US Pain Foundation, spoke in front of the Senate Committee on Health, Education, Labor, and Pensions (HELP) on February 12, 2019.2 Steinberg, an advocate for the betterment of care for members of the pain community, lives with chronic back pain as a result of a workplace accident.

In her testimony, she urged Congress to restore more balance to opioid prescribing and improve pain care overall by funding and implementing measures outlined in the Pain Management Best Practices draft report released by the above-noted Inter-Agency Task Force, emphasizing the importance of investing in research on safer, more effective treatment options ranging from medical devices to medical cannabis.

In particular, Steinberg, who spoke to the Senators while lying in a cot due to her own chronic pain condition, brought up two points that counteract the current opioid climate, including the fact that:

  • Demographic research on populations has shown that chronic pain sufferers tend to be largely female and over the age of 40 and those with opioid use disorder tend to be largely male and under the age of 30. These are two largely separate groups with very little overlap.
  • Repeated research within the chronic pain population has found the risk of addiction to be small, on average less than 8%; and in patients with no history of abuse or addiction; studies have shown the rate of addiction to be between 0.19% to 3.27%.3-5

She added, "It is essential that treating clinicians be permitted to evaluate individual benefits and risks for each patient and that all appropriate pharmacological, interventional and complementary therapies remain available." Steinberg offered 7 specific ways to improve pain care today:

  • promoting individualized, integrative, multimodal care plans
  • breaking down coverage barriers to a full range of non-pharmacological as well as pharmacological treatments
  • investing in vital collection and reporting of epidemiological data on pain
  • improving public, patient, and provider education about pain management
  • breaking down stigma that creates barriers to proper care
  • investing in ongoing patient support and teaching of self-management skills for living with a chronic illness and pain
  • increasing research into understanding the basic mechanisms of chronic pain in the human body and the development of novel safe and effective treatments. 

Read more about ongoing national efforts such as those of the Interagency Working Group on the Prevention of Acute and Chronic Pain and the National Academy of Medicine's opioid collaborative.

Last updated on: April 9, 2019
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