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Greetings! I hope everyone is finding joy and rest this summer – especially those of you living with pain. It’s been a busy time here at the National Pain Advocacy Center (NPAC). We wanted to share a sampling of our activities to keep you up to date on our work in advancing the health and human rights of people with pain.
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We’ve worked on building a better infrastructure for research and treatment of pain. We’ve worked to ensure equitable access to pain management. We’ve worked to protect those who require the use of controlled medication from discrimination in care.
Below, you will find a discussion of the appointment of NPAC members to key government committees, NPAC’s involvement in important regulatory and legislative actions, our speaking engagements, and recent appearances in the media. We’ve even been doing some globe-trotting, presenting in Canada and at the World Health Organization.
I hope you enjoy reading about our activities.
As always, NPAC takes no industry funding, and we appreciate and value your support, which enables us to continue to advance the health and human rights of people living with pain.
My warmest regards,
Kate
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Key Government Appointments
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Three members of NPAC Appointed by Secretary of Health and Human Services (HHS) to the Interagency Pain Research Coordinating Committee (IPRCC)
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Three members of NPAC were recently invited by the Secretary of HHS to serve on the federal committee responsible for overseeing all pain research in the U.S. They include NPAC Science & Policy Advisors, Tamara Baker, PhD, and Monica Mallampalli PhD, MSc, and NPAC Executive Director, Kate Nicholson, JD. All attended the June IPRCC meeting.
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When introducing this slate to the committee, IPRCC Chair Helene Langevin, MD, CM, focused on each member's expertise in health equity: Baker’s in racial inequities and pain, Mallampalli’s in sex, gender, and gender identity and pain and Nicholson’s in disability and pain.
Building and supporting the pain infrastructure is key to NPAC’s mission and vision of achieving effective and equitable treatment of pain. Pain research is a critical piece of that puzzle, especially given Congress’ annual allocation of $280 million to pain research through the HEAL Initiative. NPAC is delighted to participate in the future of pain research.
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Legislative and Regulatory Actions
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DEA Proposes Rules on Prescribing Controlled Medications via Telemedicine
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As COVID-era temporary regulations continue to expire, the Drug Enforcement Administration (DEA) has proposed to roll back telemedicine options for many essential prescriptions. The proposed rule changes require that patients be seen in person to receive prescriptions for certain controlled medications, such as many opioids and stimulants.
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For some controlled medications, including buprenorphine, which is used to treat opioid use disorder, the DEA would allow a 30-day supply to be provided via telemedicine. A patient must then arrange an in-person visit to continue to receive medication.
Adopting these rules would be a dangerous move, exacerbating already gaping disparities and imperiling the most vulnerable patients. In response, NPAC urged the DEA to revise the proposed rules to allow telemedicine prescribing of controlled substances with safeguards that do not impede access to essential medication and care. To expand awareness of this issue, NPAC also placed an Opinion piece in the Los Angeles Times.
The DEA has temporarily extended telemedicine prescribing of controlled medication.
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Colorado Adopts Law Protecting Prescription Drugs for Chronic Pain
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On May 4th, Colorado’s Governor Polis signed into law Senate Bill 23-144, an act concerning prescription drugs for treating chronic pain.
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Spearheaded by NPAC, in collaboration with Colorado-based groups focused on disability rights, older person's rights and care for people with chronic diseases, the new law will protect people living with pain who require opioid prescriptions above the dose thresholds found in state or federal prescribing guidelines or policies, prohibiting health care clinics from refusing to accept or continue to care for a patient based on the dosage of a drug the patient requires. Health systems are forbidden from having policies compelling the tapering of patients based on dosage alone. And pharmacy systems may no longer refuse to fill opioid prescriptions just because they exceed certain dosages.
Moreover, the Colorado law protects providers acting in good faith from disciplinary action solely for writing prescriptions that exceed dose thresholds specified in existing guidelines. This provision is a good example of how past NPAC policy advocacy can build and support new initiatives. In drafting the bill, NPAC was able to draw upon its success in last year's U.S. Supreme Court case, Ruan v. U.S.
The new law applies to people being treated for chronic pain, or pain that has lasted three months or longer, and it went to effect immediately upon being signed by the governor. NPAC will now work with the Colorado Medical Society to implement the law by training their providers to comply with the new legislation. This is critically important because there is a difference between having a law enacted and seeing it properly implemented.
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Speaking Engagements & Major Meetings
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Rx and Illicit Drug Summit considers chronic pain
In April, NPAC Executive Director Kate Nicholson participated as invited faculty in the Rx and Illicit Drug Summit in Atlanta, Georgia. She co-presented with Dr. Charlene Dewey, and together they offered a patient-provider perspective on the importance of shared decision-making and person-centered care in pain management. The panel was entitled “The Power of Shared Decision-Making: Collaboration With Patients and Families to Support Effective Pain Management.”
The presentation was undertaken on behalf of the National Academy of Medicine and drew upon its chronic pain journey map, a visual illustration describing the diverse experiences of persons living with chronic pain. The map identifies gaps in care and offers resources and specific action steps that clinicians, health systems, and payers can take to improve pain management. NPAC was honored to participate in what was one of the first times pain was a focus at the Rx and Illicit Drug Summit.
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University of San Francisco, Pain, and Addiction Research Center learns how policy shapes healthcare
Also in April, Nicholson delivered the “PARC Seminar” at an interdisciplinary research center at the University of San Francisco. Her topic was “Access and Equity: How the Policy Environment Shapes Care of People with Pain, People with Addiction, and Those at the Intersection.” Nicholson drew on her experiences working in health-related civil rights during the HIV/AIDs crisis and her work on behalf of people with pain today. She highlighted several examples of laws and policies today that limit access to care for people with pain and people with addiction. Nicholson then identified a vicious cycle in public health crises, in which media narratives shape policy choices, and the resulting policies often become a source of stigma and discrimination in the provision of healthcare.
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California and the Federation of State Medical Boards Consider Updates to Controlled Substance Prescribing Guidelines
In May, NPAC Executive Director Kate Nicholson testified before the Medical Board of California to aid them in updating their prescribing guidelines–which are a significant improvement toward allowing for nuanced and patient-centered pain management. At the May meeting, the Board voted to adopt the new guidelines with minor revisions suggested by NPAC and other patient testifiers. Because California is the largest state and often influential in nationwide policy development, these improvements should have a significant impact across the nation.
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Further, NPAC has been working with the Federation of State Medical Boards (FSMB) on updating and improving its guidelines. Nicholson was invited to present at an earlier FSMB meeting and, in March, NPAC submitted comments on its most recent draft. These guidelines are important to pain care nationwide, because they will inform the practices and policies of all state medical boards.
The FSMB guidelines, have not yet been finalized. NPAC will keep you updated on developments as they progress.
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Canadian Pain Society Hosts 2023 Annual Scientific Meeting
In May, the Canadian Pain Society brought together individuals with an interest in pain from all around the world to share knowledge and expertise.
NPAC’s Kate Nicholson spoke on a panel discussing the use of harm reduction strategies to keep people with chronic pain safe within the context of the overdose crisis. After providing a historical, legal, and ethical overview of a pendulum swing on opioid prescribing and its impact on the human rights of people living with pain, Nicholson presented data on the dangers of tapering and patient abandonment. She then discussed how applying harm reduction principles to the treatment of patients who use opioids can improve outcomes. Nicholson also participated as a judge for poster presentations at the conference.
Further, at the end of May, Nicholson joined Pain Canada's Executive Director, Maria Hudspith, and people with lived experience of pain from Canada to virtually conduct Grand Rounds for the Canadian Pain Society.
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Cornell University Hosts Conference on Digital Pain Technologies
In May, Cornell University hosted an extremely timely and important workshop, “Digital Pain Technologies: Promises and Problems.” The workshop brought together academics from social science and technical disciplines, along with health professionals, patient advocates, and companies, around the issue of designing systems of pain management that are more equitable, accessible, and integrated.
Among a select group of 15 experts, NPAC Director Kate Nicholson was invited to add to the workshop’s trans-disciplinary dialogue. Presenting “Equity, Access & Privacy in Remote Care: Pitfalls and Opportunities”, Nicholson discussed issues related to access and equity, privacy and security, and the use of artificial intelligence and algorithms.
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CDC, DEA, and ASTHO Host National Partner Convening
NPAC was invited to participate in a national convening hosted by the Centers for Disease Control and Prevention (CDC), Drug Enforcement Administration (DEA), and the Association of State and Territorial Health Officials (ASTHO) regarding finding care for patients using controlled substances when their provider falls under DEA investigation. Also discussed was what can be done to improve the problem of people who need pain medication losing access to their medication and to healthcare in general.
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World Health Organization addresses new codes for chronic pain
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Another important piece of building an infrastructure for better treatment of pain is getting countries around the world to adopt ICD‑11. Importantly, ICD‑11 adds codes for common chronic pain conditions, such as chronic post-surgical pain, chronic cancer pain, and chronic neuropathic pain, that were not available in ICD-10 or ICD-9.
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The codes are important to improve diagnosis of chronic pain and provide pathways for reimbursement and care. The codes also enable data collection to better understand chronic pain as a global public health issue.
In June, NPAC Executive Director, Kate Nicholson, presented pain stories to illustrate the impact these new codes could have in real patients’ lives. Nicholson presented her own pain story and those of NPAC members, Quana Madison and Ola Ojewumi.
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