Oregon has a problem with prescription pain pills. Oregon leads the nation in the abuse of such drugs, federal statistics show, with the state's rate of prescription drug abuse 39 percent higher than the national average.
Why that is, I do not know. As an Infectious Disease doctor I prescribe a narcotic about once a year. There are a real problems with the treatment of chronic pain and while I am aware of the issues and the changes over the last 25 years, it does not impact my practice, so my knowledge of the issues is basic
I am also well aware of the Oregon Health Plan, OHP.
OHP was intended to make health care more available to the working poor, while rationing benefits.
Given limited resources, part of the plan has always included a prioritization of treatments and diagnostics, paying for interventions that give the most bang for the buck. Not a perfect way to ration care and as is always the case, no good deed goes unpunished.
Another effect of limiting care, according to the Bend Bullitin, may be that
OHP members who suffer back pain have been left with no choice but to take drugs, and the policy could be contributing to Oregon's high rate of narcotic abuse
since other interventions are not paid for.
New guidelines were recently updated by the Health Evidence Review Board and as a result
The new guidelines open the door to acupuncture, chiropractic, cognitive behavioral therapy, osteopathic manipulation and physical and occupational therapy.
To be picky, they do not say chiropractic, but "spinal manipulation", although the codes suggest chiropractic manipulation.
As best I can tell, they relied on two reviews Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society from 2007 and Nonpharmacologic Therapies for Acute and Chronic Low Back Pain: A Review of the Evidence for an American Pain Society/American College of Physicians Clinical Practice Guideline from 2007.
They evidently did not review the literature to show that acupuncture is a theatrical placebo, has no basis in reality-based medicine and that most positive effects are probably due to bias
results should be interpreted in the context of the limitations identified, particularly in relation to the heterogeneity in the study characteristics and the low methodological quality in many of the included studies.
and that chiropractic is no better other therapies
High quality evidence suggests that there is no clinically relevant difference between SMT and other interventions for reducing pain and improving function in patients with chronic low-back pain.
not, as was mentioned in the newspaper, that
Large, randomized trials have shown that for chronic back pain, acupuncture and chiropractic therapy are equally helpful, said Dr. Richard Deyo, professor of evidence-based medicine at Oregon Health & Science University. He served on a task force that advised the Health Evidence Review Commission. "Different people respond to different things," he said. "The outcomes tend to be very similar, in the short term at least."
It is more accurate to say they are equal placebos, since short term improvement is just what one would expect from a placebo that does nothing to the underlying process. And placebos are unethical.
As noted many times here and at Science-Based Medicine, evidence based medicine is inadequate at evaluating interventions that are not based in reality
And this also ignores the question of the state paying for practitioners of magical pseudo-medicines and all the associated useless interventions and beliefs espoused by chiropractors, naturopaths and traditional chinese medicine practitioners.
Hardly seems like a good use of Oregon resources.
They suggest possible benefit
The expense of a broader range of treatments could be offset by a decline in narcotics use,
and I hope they do some epidemiologic studies to show benefit of adding pseudo-medicines to OHP, although I am sure the cost is worth the benefit.