SALT LAKE CITY — While Utah and the country take aim at the opioid epidemic, many with chronic pain have suffered as doctors take away or taper them off their medications, a lobbyist told legislators Monday.
There are people having trouble getting their prescriptions from pharmacies and others being "force-tapered” or having their opioid prescriptions suddenly discontinued, which can cause severe opioid withdrawal symptoms, said Amy Coombs, who has worked with substance use patients and serves as executive director of Prestige Government Relations and Consulting Group.
Coombs presented to members of the Health Reform Task Force as the group discussed opioids, health care costs and Medicaid expansion during a Monday legislative interim meeting.
In April, the Centers for Disease Control and Prevention announced its 2016 opiate guidelines have been "widely misapplied" to include those using opioids for palliative care, chronic pain and illnesses such as cancer, Coombs said.
There’s been a "broad brush stroke" of tapering or cutting people off of opioids, according to Coombs, but opioids should be considered on a person-to-person basis.
Also in April, the Food and Drug Administration issued a warning and required labeling changes after receiving "reports of serious harm in patients who are physically dependent on opioid pain medicines suddenly having these medicines discontinued or the dose rapidly decreased. These include serious withdrawal symptoms, uncontrolled pain, psychological distress and suicide."
Many do benefit from opioid therapy, Coombs said, and she's heard "more and more of those particular stories" about people in Utah who have taken their lives or suffered severe setbacks in their pain management because of their opioid prescriptions changing too quickly.
Some have turned to illegal drugs, according to Coombs. "People are not getting the care that they need."
Those who need opioids now face more difficulty finding access to quality care and providers willing to treat their chronic pain, she said. People who have been on opioids for years often have to wait for pharmacists to reach their doctors before dispensing prescriptions — and suffer withdrawal symptoms while they wait, she said.
Rep. Jim Dunnigan, R-Taylorsville, asked what could cause that delay.
Senate Majority Leader Evan Vickers, R-Cedar City, himself a pharmacist, explained that there's a "disconnect" between decisions being made by health plans and pharmacy benefit managers that "aren't necessarily medically based" but are instead often "financially based."
Health insurance plans have taken the fight against the opioid crisis as "a hard, fast rule and they don't allow a lot of leeway," Vickers said.
Opioid patients prescribed high quantities of opiates need to be tapered off slowly to get long-term results, according to Vickers. But health plans often don't allow for slower tapering.
"And that forces (the patients) into making choices that they probably normally wouldn't make," including finding drug sources on the streets, Vickers said.
Sen. Allen Christensen, R-North Ogden, noted that the opioid issue has been "beat to death." But opioids are "miracle drugs," he said.
"We have to move the pendulum back and forth a little bit. … We have to regulate it, but don't overreact with it. … We're trying to find that healthy medium in the middle," he said.
Coombs said patients have also suffered because doctors have been incentivized to taper patients off opioids and de-incentivized to treat pain patients with opioids.
She urged the task force to work on creating a palliative care definition or exemption to help those who need opioids long term receive them. She also encouraged creating "bridge" opportunities for patients to receive supplies of two to four days so as not to suffer withdrawals while doctors and pharmacists work out issues such as authorization.
Several of the legislators agreed that Coombs brought up a real problem, but a potential course of action was not discussed in the meeting.
"I think it's a problem. You have to find someone who thinks it's enough of a problem to try and do something about it," Christensen said, quipping that "a pharmacist" legislator would be a good person to tackle it.
Rep. Suzanne Harrison, D-Draper, said, "I think this raises the issue of: We need to make sure that we're providing evidence-based care and enough access to those care providers who have the qualifications."