Managing the Opioid Crisis: More Grey Than Black and White

Opioid addiction is all around us. And, contrary to the prevailing stereotype, it’s not something that only happens to “bad” or “irresponsible” or “other” people. Rather, it crosses race, gender, age and socioeconomic lines. It’s a medical condition – like alcohol addiction or heart disease – and its management requires the same type of responsible and coordinated treatment by medical professionals.

Unfortunately, and thanks in large part to the stigma and misinformation out there regarding opioid addiction, those who are responsibly attempting to manage it (in addition to all the other medical conditions that contributed to them becoming addicted in the first place), find it hard to receive the fully coordinated care that’s required.

Among other things, they are faced with primary care physicians who don’t want to take them on as patients and, if they do, who don’t want responsibility for managing their ongoing opioid prescriptions. Instead, these physicians usually insist that a pain management specialist be on the team, a requirement that can not only create an insurance coverage nightmare, but a logistical one as well.

Whew. It’s difficult and we’ve seen how disheartening a journey it can be for our clients and their loved ones. To better illustrate what’s involved, let’s consider the story of our client Helen…

The need for coordinated care

Helen Jones (not her real name) had been suffering for many years from severe pain caused by advanced osteo-arthritis of her shoulders and lower back; fibromyalgia; neuropathy from diabetes; and carpal tunnel syndrome.

Not only was she dealing with many different types of pain, she had a long-standing history during which several powerful opioids had been prescribed; a trusted pain management specialist who closed her practice; and an unforeseen change in her medical insurance coverage.

We started with Helen the way we would with any client: with a thorough understanding of her insurance plan, and to appreciate the following:

  • The network she needed to live within to have coverage
  • The primary care physicians within the network who were taking new patients
  • The referral requirements necessary for specialist care
  • The required specialists within the network
  • The requirements for prior-authorization and prior approval for services

Next, we identified a new primary care physician (PCP) willing to take on this challenging patient. We needed this person to manage preventative care and refer Helen to appropriate specialists (due to state and federal regulations, her new PCP was now quite limited in narcotic pain prescription).

Then we scheduled an appointment with a pain management specialist. This person outlined the rules of engagement and asked Helen to sign a contract in agreement.

Overcoming the stigma

Once key team members were in place, it quickly became apparent that more referrals and tests were needed to manage all the other medical conditions that needed care and monitoring.

To be most helpful to Helen, we needed to listen to her priorities, concerns and fears – chief among them, “being labeled an addict,” something that did not match how Helen saw herself.

To overcome this, we did what we do for all our clients:

  • We practiced how she would manage the interaction during her appointments by articulating her history (including her opioid addiction) and outlining her goals for treatment. This reflected Helen’s accountability and engagement in her own care.
  • We engaged appropriate family members to participate in her care.

As with many illnesses, addiction and pain management can affect the family in many ways, including the loss of the person “the way they were,” as well as the rollercoaster of emotions, finances, and helplessness that may be experienced. Unlike other illnesses, however, with opioid addiction there may also be an associated stigma that, “they brought it on themselves.”

“Trial and Error” is the norm

Because pain and pain management can be so complex, there is a great deal of trial and error involved in finding solutions. Chronic pain can occur for many different reasons and therefore requires different treatment modalities. When one approach does not work, it’s not because of incompetence of the team, but rather because transitions might be needed from one modality to another. For a person who already feels stigmatized and is often alienated from the healthcare system, this poses additional challenges.

Family members and Care Partners are critical to success because often, things feel worse before they get better. Recognizing that even the most renowned specialists rely on a “trial and error” process is helpful; pain management treatment itself isn’t usually black and white and along the way there are inclinations to give up and go back to old habits.

Conclusion

Clearly, opioid addiction and its treatment is a complex topic. Our goal with writing today’s newsletter was to encourage you to reflect on your own stereotypes; to recognize that living in the “grey area” of opioid addiction is not easy; and to provide hope that we can continue to make progress with treatment of these individuals.

P.S. Many thanks to HealthAssist Healthcare Advisor, Anne Jacoby, for her contributions to this month’s edition!