Blue Cross on Pain Reliever Abuse

It is wonderful that Blue Cross Blue Shield of Massachusetts is concerned about pain reliever abuse and that the company has consulted with some physicians about ways to curb it.

But it is extremely likely that the policy the company is set to put in place July 1, which allows patients to fill a 15– day prescription and one additional 15-day supply, will end up doing more harm than good, becoming yet another barrier for legitimate pain patients who need opioid medications.

There’s no question that a few physicians prescribe too many opioids and a few patients scam their doctors for more. But the far larger problem is under-treatment of the pain of 100 million Americans, some of whom appropriately need opioid medications.

Blue Cross’ new policy, while it may stem from legitimate, benign motivation, could end up making the lives of pain patients more difficult than they already are. Blue Cross is concerned about “doctor-shopping,” that is, patients going from doctor to doctor to get drugs in order to abuse them. But the truth is that many legitimate pain patients go from doctor to doctor not to abuse drugs but to find someone who understands and can treat their pain.

As for the concern that people who fill opioid prescriptions wind up with medicine cabinets full of left-over pills?

That’s absolutely true. In fact, according to federal government figures, that’s where most of the drugs that get diverted to street users come from. But the federal government has a totally inadequate policy for solving this.

The Drug Enforcement Administration designates on day a year (this year it was April 28) as “take-back” day (actually four hours, from 10 a.m. to 2 p.m.) during which people can take their unwanted drugs to disposal sites.

Driving the hysteria about opioid abuse is the fear of addiction. But even with long term use, the risk of addiction is far short of the 100 percent that the public seems to think. The risk of addiction is estimated to be between 4 and 26 percent, and that’s according to a conservative group, the Physicians for Responsible Opioid Prescribing.

There’s another root cause at play here. Basically, though most people haven’t digested it yet, the “war on drugs” has failed.

That’s not my conclusion. It’s the conclusion, issued in June, 2011, of the Global Commission on Drug Policy, a group that included former heads of state, Kofi Annan (the former Secretary-General of the United Nations), Paul Volker (former chairman of the Federal Reserve), George P. Shultz (former US Secretary of State) and others.

“The global war on drugs has failed,” said the group, “with devastating consequences for individuals and societies around the world….Arresting and incarcerating tens of millions of  these people in recent decades has filled prisons and destroyed lives and families without reducing the availability of illicit drugs or the power of criminal organizations.”

Blue Cross’ new policy may end up being benign. But it smacks of the old war on drugs mentality. And if it plays out that way, it could end up hurting pain patients.