About half of opioid overdose deaths involving prescription drugs. With that stark reality in mind, the surgeon general, Dr. Vivek Murthy, an unusually direct statement sent last week to 2.3 million doctors and other health professionals to help fight the epidemic of opioid treatment pain “safely and effectively.” A website for the campaign “Turn the Tide” highlights, non-addictive alternative treatments for pain. Not only doctors, but also to policy makers, insurance companies and other stakeholders in the health system should pay attention.
Prescriptions for opiates such as oxycodone and methadone have quadrupled since 1999, as the opiate overdose deaths – more than 28,000 in 2014, up 14 percent over the previous year. While opioid prescriptions peaked in 2012, their use remains high in historical terms. And many people who were prescribed opioids have moved to illegal opiates such as heroin and fentanyl.
For patients with cancer or people near the end of his life, opioids are often the only effective medicine. However, doctors have many more options for treating pain, migraines and pain associated with back surgery – physical therapy, anti-inflammatories, acupuncture, exercise and so on. Some doctors overlook these alternatives because opioids are easy to prescribe or because patients demand them.
An additional problem is that some insurance plans do not cover alternative treatments such as acupuncture and physical therapy, or impose many limits and high co-payments on them in many cases both doctors and patients find opioids a less expensive option . In some rural areas, the physiotherapist may be closer to many miles.
A solution here seems obvious: federal and state lawmakers may require insurers to cover these services, a cheaper long-term addiction treatment option. And they must also find ways to expand access to health services by subsidizing doctors, therapists and other health professionals to make regular visits to remote areas.
Even when opioids are needed, doctors can minimize the risk of addiction by taking some precautions. They can write prescriptions for low doses and relatively short periods of time. They should pay attention to monitoring programs that most states have established to ensure that a person is not getting multiple prescriptions from different doctors. And doctors can direct treatment to patients who are obviously addicted.
A new study published by researchers at the premises in the Department of Health and Human Services places that have expanded their Medicaid programs as part of Obamacare with neighboring places that have no comparison. They found that in 2015, insurance in the market for middle-income people cost less in places that had expanded Medicaid.
By comparing counties across state lines, and adjust various differences between them, the researchers estimate that the expansion of Medicaid intended market premiums were 7 percent lower.
States that choose to expand Medicaid coverage government can provide for everyone earning less than 133 percent of the federal poverty level, about $ 16,000 a year for a single person. People who earn more can buy insurance in the new markets of Obamacare.
However, in states that do not expand, the rules are a little different. People with incomes below 100 percent of poverty level generally do not have another option for subsidized coverage. But people who earn between 100 percent of the poverty level (just under $ 12,000 per year) and 133 percent can purchase subsidized coverage market. The H.H.S. report argues that these people that help explain the difference in premium.
A substantial body of research has shown that low-income Americans tend to have worse health than those who earn more. (Cause and effect is not clear: People may be unable to earn a higher income due to health problems.) And that difference may explain why insurance premiums Medicaid expansion may have decreased. Because the states that had expanded sicker in its insurance fund of the middle class, prices rose for all, the paper argues.