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Letter: Pain and Medicaid

I was struck by your article (Monitor, July 3) stating that “the rising rate of substance abuse, especially for highly addictive opioids, is a serious public health and safety challenge and Gov. Hassan is working to address this crisis.”

As a health care provider in pain management, I work very hard to responsibly prescribe medication to my patients.

I practice conservatively and with many measures in place to ensure the safety and compliance of my patients. My frustration lies with the state Medicaid program.

I am almost always denied prescribing my patients a conservative, long-acting medication, despite my belief that it is the right treatment for them.

Medicaid tells me my patients must try and fail at least two long-acting, potent opioid medications before they will consider approval. Those medications include fentanyl, Oxycontin and morphine (still good pain medication when used for the right patient). The article says the prescription of these drugs is what leads to abuse, yet Medicaid says I must prescribe them first.

I am prevented from trying to appropriately and conservatively prescribe a long-acting pain medication with miniscule risk of abuse.

I do not disagree that substance abuse is a serious public health crisis that needs to be addressed. The drug monitoring program will be a huge asset to those of us who prescribe pain medication. But you can’t play on both sides of the fence, calling it a crisis for the state while Medicaid forces providers to prescribe the very medications to which you attribute the crisis.



(The writer is a pain management specialist.)

Legacy Comments1

Kathleen, You are spot on. I do not envy the job of legislators, weekly exposed to passionate arguments with dramatic metaphors and predictions of dire consequence if THIER recommendation is not adopted. Adding to the problem is the subjective nature of chronic pain. They can't see validation of the problem like they can an amputation or wheelchair. The add on the the regrettable incidence of malingering. Sounds like your use of multimodal pain management and responsible prescription of opiates is how it ought to be done. How do we help the legislators understand the difference between responsible practices like yours and the "pill mills"?

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