Op-Ed: Americans Deserve Pain Management Beyond Opioids
— Ophthalmologist decries Medicare rules that discriminate against alternative painkillers
As an ophthalmologist for the past 29 years, I know that Americans who need cataract surgery are greatly affected by treatment options available to ophthalmic surgeons who perform the procedure. Unfortunately, vital treatments that improve patient health outcomes and eliminate the need to use opioid-based painkillers are difficult to access thanks to cumbersome Medicare regulations.
Although cataract surgery enjoys an overwhelmingly high success rate, any patient who undergoes the procedure can face a variety of risks. Like most surgical procedures, cataract surgery inevitably involves some degree of discomfort. To reduce discomfort during surgery, the ultrapotent opioid fentanyl is sometimes administered to patients. In a few cases, opioids might be prescribed to address post-surgical pain.
To be sure, utilizing prescription opioids to mitigate intractable pain for patients can sometimes be appropriate and necessary. But as we have seen over the last decade, opioid-based drugs can also expose individuals to a myriad of downstream risks. The opioid epidemic, which has wreaked havoc in communities across the country, bear testament to this fact. According to a recent study, every year roughly 3 million Americans become persistent opioid users following surgery, a startling reality that underscores the need for effective pain management alternatives beyond opioid-based painkillers. With the U.S. witnessing an average of 130 opioid-related overdose deaths every single day, it is critical for medical professionals to help prevent addiction.
To help mitigate the risks associated with opioids, doctors should be able to take advantage of alternative pain management approaches that relieve patient discomfort without exposing them to downstream risks of addiction. When it comes to cataract surgery, one proven alternative already exists, but it is unfortunately subject to frustrating access barriers put up by Medicare.
As the only FDA-approved drug for use during cataract surgery to maintain pupil size by preventing intraoperative miosis while reducing postoperative ocular pain, Omidria (phenylephrine and ketorolac intraocular solution) 1%/0.3% is an innovative treatment approach that reduces the need for opioid-based painkillers.
The benefits of Omidria — both perioperatively and in the postoperative setting – are well documented. Peer-reviewed literature shows how Omidria reduces costly complications, such as sight-threatening cystoid macular edema and intraoperative floppy iris syndrome, and the need for pupil-expansion devices such as the iris hook. Importantly, a recent study has shown that use of Omidria reduced by nearly 80% the need for fentanyl during surgery.
As an ophthalmologist, I’ve seen the benefits of Omidria firsthand. That’s why I’m concerned that ill-conceived Medicare reimbursement policies are stifling patient access to this innovative treatment.
Despite robust evidence showing the clear benefits of this drug, Medicare rules treat Omidria as a surgical “supply” like staples, stitches, or gauze. This allows Medicare to avoid reimbursing the treatment separately. In turn, this creates a perverse incentive structure that dissuades ophthalmology practices from stocking it. By reducing access to this FDA-approved medication that has shown to improve surgical outcomes, CMS is not only out-of-step with virtually all other insurers including the U.S. Department of Veterans Affairs, it also inadvertently exposes patients to other surgery-related risks.
Patients deserve better. That’s why I’m calling on Congress to pass the bipartisan Non-Opioids Prevent Addiction in the Nation (NOPAIN) Act (S. 3067/H.R. 5172). If passed, this legislation would mandate separate Medicare reimbursement for non-opioid treatments used to help patients manage pain in the ambulatory surgery center and hospital outpatient department settings. The result would be a reduced reliance on opioids and increased provider and patient access to non-opioid pain management treatments.
It’s critical to note here that the NOPAIN Act does not seek to ban opioids. As noted, some patients may need access to opioid-based medications to manage their pain effectively. Instead, this legislation simply levels the playing field by giving providers a wider breadth of options when seeking to mitigate the pain and discomfort that result from surgery-related complications.
As America’s Medicare-age population continues to grow, expanding access to pain management alternatives beyond opioids will become ever more critical. I therefore urge our congressional delegation to safeguard patient safety by supporting passage of the NOPAIN Act into law.