Opioid Insanity

Let me begin with several presumed facts:

1) There is an opioid problem, crisis, epidemic in the United States.

2) I personally use an opioid for a pain issue I have been treating for over fifty years.

3) I have at various times in the past 5+ decades had acupuncture, acupressure, chiropractic manipulation, cortisone injections, prolo-therapy, massage and literally scores of salves, balms, lotions, tinctures, pill, capsules, powders, back braces, straps, devices including electric stimulation, both light and laser therapy. Most of these interventions have been legal according to the FDA.

4) I hold a Ph.D. degree in psychology and as such claim to have a fairly well-rounded understanding of the roles of pain, pain management and the medical establishment.

Hence, begins my story.

Last week, I had my semi-annual appointment with the pain-management physician. After consultation, he renewed my medication. The new order was transmitted to my pharmacy and I shortly received the text notification that my prescription was delayed pending a insurance review. This was expected.

Within 48 hours a new message informed me my prescription was available. When I got to the pharmacy I was asked if my insurance company has informed me of the one week limit they were willing to pay for. I had not been thusly informed. The pharmacy technician said a lot of patients were running into this new insurance edict.

I was informed that I was considered "opioid naïve" and that the insurance would only pay for 14 pills for one week. Then I would be required to see my physician again (and pay the $40 co-pay again) for another prescription.

Here is the math. I currently get 30 capsules every 6 months. The insurance company wants to pay for 14 pills every 7 days. 

In the midst of an opioid crisis (see #1 above) the insurance company believes I and my physician are not intelligent enough (see #4 above) to correctly manage my pain. The insurance company wants me to take MORE drugs than I am taking by a factor of nearly twelve times more.

Crazy? Ridiculous? Counter-intuitive . . .

But wait there's more. My pain doc also requested that before I my next visit I should take one pill the night before and one the morning of my appointment, so that I will test positive for the opioid. It seems the government needs proof that I am taking my pain meds and not selling them on the street. So once every six months, whether I need them or not on my appointment day I have to take medication to satisfy big brother.

Not one but two instances where during this 'crisis" (#1 above) a well-managed pain patient (#2 above) is required to take pain medication to satisfy medical bureaucracy. Who might a rational person ask should be making such decisions? The patient (#3 & #4 above); the patient and their physician; the insurance company; the government?

Perhaps the problem is I am just too naïve.