Switching From Opioids to Other Pain Treatments Can be Challenging, Experts Say

As the Obama Administration and public health officials push for a reduction in prescription opioids, they are facing some resistance from both patients and doctors, experts tell The New York Times.

Insurance coverage for alternative treatments is inconsistent, the article notes. The plans may not cover all treatments, or they may impose strict limits on coverage. Alternative pain treatments include acupuncture, yoga, chiropractic and osteopathic manipulation, massage, meditation and cognitive behavioral therapy.

Medicaid does cover physical therapy for patients who gained coverage under the Affordable Care Act, but the level of coverage varies by state.

Matt Salo, Executive Director of the National Association of Medicaid Directors, says benefits for alternative treatments are often the first to be eliminated when budgets are cut, because they are considered optional. A complicating factor is the widely varying amounts of evidence about the effectiveness of these treatments.

Many patients resist nondrug treatments for pain, because taking a pill is faster and easier than having to leave work for physical therapy. Doctors are often used to simply writing prescriptions for drugs.

In March, the Centers for Disease Control and Prevention (CDC) issued guidelines that recommend primary care providers avoid prescribing opioid painkillers for patients with chronic pain. The risks from opioids greatly outweigh the benefits for most people, the CDC said.

Primary care providers write nearly half of all opioid prescriptions, according to the CDC. The new guidelines are designed for primary care doctors who treat adult patients for chronic pain in outpatient settings. They are not meant for guiding treatment of patients in active cancer treatment, palliative care, or end-of-life care, the agency said.

Doctors who determine that opioid painkillers are needed should prescribe the lowest possible dose for the shortest amount of time, the guidelines state.