“No one will overtly say, 'I'm doing this to not get a bad score,” But in the back of their mind … and knowing they'll be publicly rated, I think it leads to making that subconscious decision.”

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“Legislation alone won't end this epidemic, but working together with the community, we can fight back with a multifaceted approach that prevents drug addiction before it begins and offers treatment and recovery to those who need a helping hand and a chance to heal.” – Rep. Tim Walberg (R-MI)

Indeed, notes Kaiser, a 2014 survey of 150 doctors found that roughly half said they feel pressure to prescribe painkillers based on such performance ratings.

At the same time, the federal government is telling physicians that they have been prescribing far too many opioids. In a new guideline on opioid prescriptions released in March, the Centers for Disease Control says doctors should much more closely scrutinize requests for opioid prescriptions from patients and that it should closely monitor patients on painkillers for signs of abuse or addiction.

“Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain,” states the first of 12 recommendations from the CDC. “Clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient.”

Medical groups are urging the feds to rethink the patient surveys, and the government appears to be listening. A spokesman for the Department of Health and Human Services told Kaiser that it is considering re-writing the survey to focus more on the information the doctor provides the patient about pain management, rather than the patient's satisfaction with the outcome.

– Jack Craver

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“This is a disease, this is a chronic condition that has to be interrupted and treated and prevented if possible.” – Hillary Clinton

Seniors facing a painful retreat from opioid treatment

Chronic pain and opioid drugs combine a nasty condition with an equally nasty treatment. For many Americans, treating pain with narcotic pharmaceuticals has become a habit, one encouraged for years by the medical profession.

But now, as Paula Span writes in the New York Times, the nasty couple may be breaking up.

As media and medical professionals continue to track the growing “opioid crisis,” suddenly what was once a panacea for the suffering of many seniors is now being attacked as the enemy. Using opioids has been rebranded as a dangerous method that makes the elderly lazy, dependent and incapable of following safer treatment programs that don't include opioids.

Span notes the irony of the chronic pain-opioid evolution. Prior to 1999, chronic pain was not officially considered to be a treatment priority for physicians, who tended not to prescribe painkillers to patients complaining of chronic pain.

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Most common drugs involved in prescription opioid overdoses: methadone, oxycodone, hydrocodone

Nearly one-third of opioid prescriptions acquired by employees through their employer-backed insurance are being abused.

In that year, the Veterans Administration (now the Department of Veterans Affairs) cited chronic pain as one of five key “vital signs” of patients, which increased the pressure on doctors to treat pain with opioids. Hospitals and clinics began to be evaluated on how well they managed patients' chronic pain, and opioid prescriptions increased dramatically.

Today, as the federal government reverses course on treating pain with opioids, many doctors and their patients are hooked on the treatment.

But the tide is turning. The Centers for Disease Control and Prevention came out with new, more-restrictive guidelines for opioid treatments. States are cranking out their own laws to limit opioid use, and a reclassification of some of the drugs makes them harder to come by.

Rather than prescribing painkillers, physicians are now being told to prescribe therapy and healthier habits, such as better diets and more exercise, to control pain. Good luck with that, Span says. “Some of their doctors are going to get an earful when they suggest different medications or nonpharmacological alternatives,” she writes.

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94% of those in treatment for opioid addiction turn to heroin because prescriptions are 'more expensive and harder to obtain,' according to a 2014 survey.

Seniors may have cause for concern if their physicians turn on a dime to replace their current meds with any of the new drugs coming on the market designed to augment or replace opioid use. Span notes that the side effects of some new drugs are serious and could do more harm than good.

With the national focus on deaths related to opioid overdoses, seniors with chronic pain will be forced to change the way they treat the aches and pains of growing old. And, Span warns, that could be a frustrating and expensive shift until a new anti-pain paradigm emerges. For instance, cognitive behavioral therapy has shown positive results with some pain patients.

“But not enough practitioners offer alternatives like cognitive behavioral therapy, and insurers (including Medicare) generally won't pay for them,” Span writes.

So, not only will new treatment methods need to be explored, but insurers will have to be convinced to help seniors pay for them. And that's almost as nasty a combination as chronic pain and opioid drugs.

– Dan Cook