An Oregon proposal to expand alternative treatments for certain chronic pain conditions while limiting the use of opioids has moved forward with minimal changes, despite outcries from chronic pain patients and sharp criticism from pain experts across the country.

The state’s Chronic Pain Task Force, an ad hoc committee providing recommendations on treatments for chronic pain under Oregon’s Medicaid program, backed a proposal to provide coverage for five chronic pain conditions currently not covered by the Oregon Health Plan.

Taper off Opioids

Patients who are already taking doses above the opioid limits would be required to begin a taper of their medications at rate determined in conjunction with their doctor. Patients with fibromyalgia or centralized pain syndrome would be required to taper off opioids completely.

Overprescribing of prescription opioids has been blamed for the ongoing overdose epidemic nationwide. With other states wrestling with the same issues, Oregon’s proposal has garnered national attention and concern.

“This is basically more extreme and draconian than any approach in the country. It goes against all of the guidelines,” said Kate Nicholson, a civil rights attorney from Colorado and a chronic pain advocate. “And importantly, it does so without regard for any attempt to measure potential harms or benefits to patients.”

Hargunani said the revised proposal recognizes that for some patients, long-term opioids can be an appropriate treatment and would not require a full taper off the drugs. For those for whom opioids are not appropriate, the ultimate goal would be a taper to zero.

General guideline on Opioids

The Oregon proposal, however, is not intended to be a general guideline on opioids for chronic pain, and task force members stressed that it would not apply to chronic pain patients across the board.

“These were things that were not covered at all,” said Amber Rose Dullea, a fibromyalgia patient and member of the task force. “So if somebody is seeing a doctor under the Oregon Health Plan and they’ve been getting opioids, this line would not have any effect, because if they had gone to a practitioner prior, they wouldn’t have gotten any treatment.”

A combined statement from the Oregon Medical Association and the American Medical Association called for modifications including language stating that “neither patients nor physicians should ever be forced into nonconsensual tapering protocols.”

The task force considered a review of the evidence supporting the safety and effectiveness of tapering patients, conducted by researchers from Oregon Health & Science University. That review found there was little evidence to suggest that tapering patients off opioids improved pain, functioning or quality of life. Similarly, there was little information about the potential risks of weaning patients off opioids.

The vast majority of people who die from opioids are actually dying at lower doses, he said, because most people are on lower doses. And there is little evidence to say whether patients on high doses of opioids are more at risk staying on those high doses or tapering down.

The proposal now goes to another committee for consideration at its January meeting, and if approved will go to the full Health Evidence Review Commission for consideration as early as March.