Lawmakers eye legislation for pain treatment without drugs

WARREN — Prescribing pain medication to cover up chronic pain, rather than paying to treat the cause, is still the preferred method of operation for insurance companies — including Medicaid — according to a report compiled by the Ohio State Chiropractic Association Opioid Task Force.

Several state lawmakers in Trumbull County districts, after reading the report and another from the U.S. Department of Health and Human Services’ Office of Inspector General on opioid prescriptions in Ohio, want to study the issue further and are considering drafting legislation that would require health insurance providers to pay for alternative treatments.

The task force, co-chaired by Howland chiropractor Dr. Patrick Ensminger, surveyed Ohio chiropractic physicians to determine how health insurers in the state offer coverage for their services.

“I’m sorry to say, Ohio’s insurance companies appear to be doing more to perpetuate the problem than to prevent it. The results point to insurance companies still pushing opioids and other drugs because they perceive them as being less expensive than non-drug care such as chiropractic,” Ensminger said.

Medicaid and Medicare offered the poorest reimbursement to providers, according to the task force’s report, even though people who use Medicaid are more likely to have chronic pain, the HHS IG report states.

West Virginia recently passed a law requiring all insurance providers in that state, including Medicaid, to provide coverage of non-drug care for up to 20 visits per claim, Ensminger said.

“Despite Ohio having an even larger problem than West Virginia, there is no such law existing or in the works in our state. Our task force recently completed a statewide survey to determine if our doctors were seeing any positive change in Ohio’s major insurance providers toward providing greater access to and coverage for non-drug treatment for pain. Countless state and national organizations have recommended this change as an effective way to get ahead of the opioid crisis by stopping it at its origins,” Ensminger said.

The less we rely on opioids, the more we are going to need to test alternative methods, said Ohio Sen. Sean O’Brien, D-Bazetta.

“I have my aides looking into the West Virginia law. We want to do some research first. We have to be careful because we are legislators, not doctors, and we have to look out for the interests of our constituents,” Sen. O’Brien said. “There is a lot of talk right now about how to deal with pain, a lot of talk about how to treat the cause of pain instead of covering it up. There is muscle manipulation, yoga, stretching, physical therapy and acupuncture. It is worth exploring because the fewer opioids out there, the better.”

Before the pain pill industry took off three decades ago, medical experts were having good results managing pain with non-drug methods — like exercise, nutrition, counseling and physical therapy, Ensminger said. But the insurance companies at the time perceived the methods as more expensive than opioids and other drugs, Ensminger said.

“As a result, these wonderful methods of managing pain were allowed to dwindle on the vine and largely disappear in favor of drug-based pain management,” Ensminger said. “Fast forward 25 years to the largest and most expensive healthcare crisis we have ever faced and our survey reveals that not much has changed in the way insurances treat safe, effective, drug free care.”

Rep. Michael J. O’Brien, D-Warren, said he thinks introducing a bill in Ohio addressing the issue is an excellent idea.

“I’ve been talking to my policy personnel in Columbus. We are going to start drafting some legislation with the legislative service commission that would require insurers to cover chiropractic care, and the like — with no limits on visits — prior to opioid prescriptions for chronic pain,” Rep. O’Brien said. “Physical therapy and other non-pharmacological treatments require more than one or two visits every now and then. There should be no limit on these kinds of treatments.”

The HHS IG report focuses mostly on prescriber behavior, opioid consumption statistics in Ohio and what efforts are being made by the state to curb the opioid crisis. But, the report does not address the coverage and reimbursement policy the agency’s plans offer for alternative care.

The task force’s survey found Medicaid and Medicare were likely to have the highest level of treatment and financial restrictions for chiropractic and non-pharmacological treatment compared to all other payers.

“Encouragement of these alternatives to opioids by Ohio’s healthcare payers is extremely rare. Guideline recommendations made for chiropractic and non-pharmacological alternatives to opioids will have little effect on patient care until payers modify their policies to be consistent with medical guidelines,” the task force’s report states.

Despite guidelines calling for more careful prescribing behavior from physicians, one in six Medicaid beneficiaries in Ohio in 2016 and 2017 received an opioid prescription, according to the federal report.

“In addition to the risk of abuse and misuse, opioids carry a number of health risks. Side effects from using opioids may include respiratory depression, confusion, tolerance to lower doses and physical dependence. Prescription opioid abuse can also lead to the use of illegal drugs such as heroin. For these reasons, it is essential that Medicaid and CHIP beneficiaries receive only medically necessary opioids in the appropriate amounts,” the report states.

Many of the beneficiaries were children. Between June 2016 and May 2017, the length of the federal study, 40,500 Ohioan children were prescribed the meds.

“Research shows that even using prescription opioids for legitimate purposes before high school graduation is associated with increased risk of future opioid misuse,” the HHS IG report states.

Ohio Rep. Glenn Holmes, D-Girard, also said he plans to meet with Ensminger in the near future to discuss how he can help turn the tide in Ohio.

“I believe that requiring insurance coverage for non-pharmacological and alternative treatment methods for chronic pain will go a long way in curtailing the opioid crisis. Although I’m not a doctor and, realizing the current condition of our society relative to the drug crisis, prescribing opiates should be the last treatment prescribed to manage pain. The results of the current strategy have proven devastating to Ohio and America. I believe the more we use alternative pain management methods, the more affordable these methods will become. Why we would continue to incentivize this highly addictive form of medicine is beyond me,” Holmes said.



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