PAINKILLER LAW: Public Health, not Public Prosecution

Two recent news items are particularly encouraging to anyone who thinks that an aggressive law enforcement approach is not the best way to handle the nation’s opioid painkiller crisis. In one story, a major workers compensation insurer says “yes” to a national collaborative pilot program; in the other story, a governor says “be careful” to a powerful new painkiller on the market. Both stories suggest that the smart approach is to treat the opioid painkiller crisis like the public health problem that it is, and not a law enforcement issue in which doctors are targeted as criminals.

First, Applied Underwriters, a national workers compensation insurer, announced last week that it has launched a pilot program in response to all the injured workers who’ve been prescribed opioid painkillers and whose return to work has been delayed or prevented by drug dependency. The idea is to bring doctors, pharmacists, and adjusters together to assess the appropriateness and risk of opioid treatment in each patient, decrease duration and amount of medication use for those patients prescribed the drugs, and help injured people get back on the job sooner without their medical treatment becoming a new medical issue itself. To me, this program reflects the insurer’s understanding that a lot of injured workers have been prescribed a lot of opioids, and it has often led to unexpected consequences in the form of delayed and less healthy return to work. But you don’t see Applied Underwriters saying that the problem is attributable to a criminal class of physicians who’ve willingly wreaked havoc on their patients and the economy.

Second, Vermont’s governor, Peter Shumlin, just declared a new rule that Vermont would restrict patients’ access to the new powerful painkiller Zohydro. Zohydro, as I’ve written about, is now on the market, and its availability as a pure-hydrocodone medication has caused a lot of concern nationwide about new risks of drug dependency. Vermont’s rule makes it tougher for patients to get Zohydro by making it tougher for doctors to prescribe it; while physicians still have access to the drug if a patient needs it, there are additional requirements of medical evaluation and risk assessment. Shumlin wants to find a middle ground between trying to ban the drug outright, as has been done in nearby Massachusetts, and “repeating the mistakes we made with OxyContin” in being late to awareness of the dangers of these powerful narcotics.

The common theme in these stories is that learned, caring people in both instances want to approach the problem of opioid dependence reflectively, not reflexively, and want to help patients avoid or tackle drug dependency. Neither the insurance company nor the State of Vermont is calling for raiding parties to hunt down doctors as though doctors were the main cause of the problem. Instead, it again seems like people who know what they’re talking about are looking to the drugs themselves as the problem’s source. In this way, these stories are good indicators that when we take the time to truly learn this issue, and not just jump on the bandwagon of “doing something,” the opioid crisis in our country comes to be seen for what it is: A public health problem, not a law enforcement issue. It may be too early to say the tide is turning, but these recent stories are welcome slivers of light in the dark night many doctors are unfairly enduring.

Leave a Reply