Avoid collateral damage in war against opioid abuse

Over the past four years, Minnesota legislators and medical providers have teamed up to right a major wrong — the widespread abuse of opioid painkillers, a public health crisis fueled by drug companies' deceptive and self-serving claims about these medications' safety.

The collaboration has yielded pioneering prescribing guidelines for using these drugs. The Opioid Prescribing Quality Improvement Program also mines prescription data from medical assistance programs and yields periodic report cards sent to individual medical providers indicating whether their use of these drugs is within recommendations. Already, there's been real progress. In January, the state Department of Human Services (DHS) announced a 33% reduction in new opioid prescriptions for Minnesotans enrolled in state health programs.

The state's admirable battle to rein in opioid abuse remains ongoing. But there are always opportunities for improvement, even in programs with the best of intentions. Cammie LaValle's struggles to control her pain, featured in a recent Star Tribune story, suggests that adjustments are needed to prevent the zeal to combat opioids from inadvertently leaving behind some patients who will suffer without these drugs. The state's Opioid Prescribing Work Group, whose 18 members are mostly medical professionals, need to communicate much more clearly that the program still allows prescribing flexibility for patients with complex medical needs.

LaValle, a 51-year-old Farmington resident and former paralegal, has a disease known as complex regional pain syndrome. The disease often starts in one limb but can spread elsewhere. "The key symptom is prolonged severe pain that may be constant," according to the National Institute of Neurological Disorders and Stroke. The pain is often described as a burning sensation or feeling like pins and needles.

LaValle, during an interview, ticked through the options she's tried that are often offered up as alternatives to opioids. She's already doing physical and occupational therapy. She already takes other medications, such as ibuprofen, and has tried other treatments, such as Botox, without relief. She's not a candidate for implantable devices that are an option for some. And her insurance won't cover one expensive treatment, a plasma infusion, that provided elusive relief.

But now, LaValle said, she's being tapered off a pain medication. She believes that the new opioid prescription guidelines have made her provider's clinic anxious about continuing these drugs. A call to the Minnesota Medical Association, which represents more than 10,000 state doctors, also yielded concerns about whether the guidelines and the report cards have had a "chilling effect" on doctors. The organization voiced caution during last year's legislative session that there are patients with chronic pain for whom tapering opioids may not be appropriate.

It is reassuring to hear from work group members and DHS officials overseeing the program that flexibility to help patients like LaValle is a critical priority. The problem appears to be that this message has not been communicated clearly enough or it's been undermined by vague and somewhat ominous language on the DHS website about providers needing "quality improvement" if their prescriptions fall far enough outside guidelines.

Having the work group complete an undone task would aid this communications gap. Program information states: "Providers whose practice involves treating patients with very severe pain may be eligible to demonstrate special cause variation. Additional information about how to request an exemption due to special cause variation will be provided in 2020." Work on this should have been finished before now, but hasn't been. Doing so swiftly would send a strong signal about flexibility, how it works and who is eligible.

The Legislature also has a role to play. The work group is adding two new members, both pain patients, but they do not have voting rights. Lawmakers would need to make a statutory change to give them full status. They should do so, and seek out feedback from LaValle and other pain patients about how the program is working.

These suggestions for improvement do not take away from the commendable strides in the battle against opioid abuse. Those who have labored hard on this program deserve Minnesotans' thanks. Now, it's just a matter of improving upon the good work that's already been done.