Philadelphia has made numerous efforts to address the opioid epidemic—but too little has been done to increase access to non-opioid treatments for pain.
Guidelines such as those written by the CDC and the Philadelphia Department of Public Health hope to reduce the availability of prescription opioids as one solution to combat the epidemic. Instead of opioid medication for pain management, these guidelines recommend that providers offer non-pharmacological treatment such as physical and behavioral therapies. Unfortunately, most people cannot access these treatments or are unaware how they can help — both concerns that likely contributed to the opioid crisis in the first place.
Evidence supporting non-pharmacological pain management is nothing new. Approaches such as cognitive behavior therapy, exercise, and physical therapy can provide relief for the estimated 25 million U.S. adults who experience pain daily. Given the evidence supporting these treatments, it is surprising how long healthcare has marginalized them in favor of riskier, more expensive approaches like surgery and medication. Why are the treatments widely recommended in guidelines to address opioid use so challenging to access?
Insurance coverage limits access. Insurance companies do not pay for non-pharmacological treatment options as often or at the same rate as medical options. Even when insurers pay for non-pharmacological care, other barriers such as requiring prior approval for treatment and limiting number of visits restrict access. Providers who offer non-pharmacological care are less available because it is not as easy to pay them. The healthcare system promotes approaches like medication and surgery that insurance reimburses more easily and at reasonable cost.
Lack of information about non-pharmacological pain care also limits its use. Surprisingly few individuals understand non-pharmacological treatments for pain management. Despite the evidence, a good deal of skepticism remains among patients and providers that these treatments work to manage pain.
Pharmaceutical companies have well-funded marketing plans to promote their products. Who promotes exercise and cognitive behavior therapy to the same degree? While City Council has considered legislation to regulate pharmaceutical marketing, the Department of Public Health has not done enough to increase public awareness of non-pharmacological approaches to reduce pain.
Too often, policy efforts to end the opioid crisis restrict access to opioids without increasing the availability of care beyond the status quo of drugs and surgery—reducing opioid overuse is the target, rather than improving pain management. While these efforts are important to address the urgency of the epidemic, none will solve the challenges in pain care that contributed to the epidemic in the first place. We cannot solve a problem of over-prescription with other medications, and we cannot reduce opioid misuse while limited access to all forms of treatment continues. People with pain need help understanding and accessing all their options. Current efforts to reduce prescription opioid use may restrict and stigmatize one available treatment without promoting helpful alternatives.
What’s missing is a systematic, well-funded approach to caring for people with pain while simultaneously improving access to substance abuse treatment. We cannot be lulled into believing that most current legislative and policy offerings are more than short-term fixes for a long-term, complex problem. Chronic pain is a disorder that impacts every aspect of an individual’s life. Opioid medication can be an appropriate tool for some and should be available to those who need it. Insurance companies and healthcare should increase access to all evidence-based treatment options for pain management. Public health groups need to educate about the value of non-pharmacological treatment and reduce barriers to use.
In combination with other efforts, treatment recommendations like those represented in the city’s guidelines can cumulatively tip the balance towards improvement in the opioid epidemic. However, in the absence of a comprehensive shift in pain care, some policies may inadvertently cause harm as options to manage pain become stigmatized and difficult to access. If we want to curb opioid use, we need better access to all the treatments that help providers and patients manage pain.