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New Opioid Law Emphasizes Non-Drug Therapies for Pain

  • State: West Virginia
  • Topic: Top
  • - Popular with: Insurance
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Using alternatives to opioid therapy for treating non-cancer chronic pain, a recommendation of medical guidelines including those from the Centers for Disease Control and Prevention, will soon be a requirement of West Virginia state law.

Under Senate Bill 273, health care practitioners treating a patient “for any of the myriad conditions that cause pain” will be required to refer the patient to alternative treatments before prescribing an opioid.

Those alternatives may be physical therapy, occupational therapy, acupuncture, massage therapy, osteopathic manipulation, a chronic pain management program or chiropractic service.

The alternative will be selected “based on the practitioner’s clinical judgment and the availability of the treatment.”

Gov. Jim Justice signed the bill into law on March 27. The wide-ranging opioid bill, which also includes supply limits on initial opioid prescriptions for acute pain, takes effect on June 7.

Chad Robinson, executive director of the West Virginia Chiropractic Society, said SB 273 doesn’t prohibit doctors from prescribing opioids for pain. But if they do, they will need to document why the opioid is needed instead of, or in addition to, the alternative treatment, he said.

For example, an opioid might be needed to relieve pain from a broken bone, Robinson said. But in a case of low back pain, the alternative therapies are often a better option.

“Instead of hiding the pain through the prescribing of an opioid, we should seek alternative treatment,” said Robinson, who called SB 273 “landmark legislation.”

The law would allow a practitioner to simultaneously prescribe an opioid and prescribe or recommend any of the alternative treatments.

The Centers for Disease Control’s opioid prescribing guideline, released in March 2016, states that “nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain.”

And other states are taking steps to encourage doctors to use alternative therapies instead of opioids.

In 2016, the Oregon Health Plan, the state’s version of Medicaid, began prioritizing physical therapy, chiropractic and other complementary treatments over painkillers and surgery for many types of back conditions.

The Ohio Bureau of Workers’ Compensation adopted a rule that took effect on Jan. 1 under which lumbar fusion surgery for low back pain will be authorized only if conservative care is tried for at least 60 days. The care should avoid prescribing of opioids if possible, the rule states.

The mandates are needed to reduce opioid prescribing at a time when many providers might not be familiar with alternative therapies, said California chiropractor Gerry Clum.

“The system doesn’t understand how to implement non-pharmacological approaches to pain management,” Clum said.

Clum said West Virginia may be unique thus far in its legislative approach to the issue.

West Virginia’s new law will also require insurance companies operating in the state to cover at least 20 visits to alternative therapy providers for treatment of pain. And patients will be able to seek treatment from alternative therapy providers without a doctor’s referral.

BrickStreet Mutual Insurance Co., which maintains a large piece of the workers’ compensation market in West Virginia, declined to comment on SB 273. Jeffrey Brewer, vice president for public affairs at the Property Casualty Insurers Association of America, did not respond to a request for comment on Thursday.

SB 273 will restrict initial opioid prescriptions for acute pain to four days for emergency rooms or urgent care center; three days for dentists and optometrists; and seven days for other providers outside of ERs or urgent care centers.

The bill includes registration requirements for medication-assisted treatment offices. And patients receiving Schedule II prescriptions for more than seven days must sign a narcotics contract, agreeing to see only that prescriber and a single pharmacy for the drug. The rules don’t apply to cancer patients, hospice care or those being treated for opioid dependence.

“By adding these limits, positive requirements and additional documentation standards, West Virginia is significantly raising the bar to limit access to opioids to address the ongoing opioid crisis.” Charles Johnson, an attorney with Frost Brown Todd, said in a blog post this month.

In an interview, Johnson said training should be offered to providers on complying with the new requirements. Other tools, such as checklists, would also be helpful.

He advised providers to carefully document their decisions to prescribe opioids or alternative therapies. Their decisions could lead to actions before the state medical board, or in lawsuits.

“I would really go overboard to document,” he said.

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