Our hospitals and health clinics are constantly evolving, perhaps never more quickly than during the COVID-19 pandemic. Across Pennsylvania, medical facilities have made rapid changes to accommodate new patients while keeping staff safe as they treat patients with COVID-19. But the crisis is not over; and as states across the country begin to see an uptick in new cases, challenges remain. While hospitals themselves must continue to maintain on-call staff and critical supplies of medicines, we need federal action to combat additional challenges, particularly those that occur outside hospital walls.
Throughout the country, the COVID-19 pandemic has caused a surge in drug overdose deaths, and the crisis is likely to become worse if federal officials do not intervene. Preliminary national data from the Centers for Disease Control and Prevention shows approximately 71,000 reported overdose deaths in 2019, which is a 4.6% increase from 2018. For Pennsylvanians this trend is particularly alarming.
Our state has long struggled with high rates of opioid addiction. In 2018, we saw the fourth highest rate of opioid-related deaths in the nation, and in many parts of Pennsylvania, the crisis has only escalated since. From Allegheny County to south central Pennsylvania to Philadelphia, communities are reporting increased opioid overdose incidents and grappling with addressing an ongoing epidemic in the storm of the COVID-19 pandemic.
Rural Pennsylvania, however, stands at an ever more heightened risk. The opioid epidemic has been shifting toward rural Pennsylvania in recent years, and COVID-19 is already challenging a rural health care system stretched thin.
As the president of the Pennsylvania Rural Health Association (PRHA), the increase in addiction rates in Rural Pennsylvania, unfortunately, does not come as a surprise. With fewer dedicated public resources and often limited access to addiction care, Pennsylvania’s rural areas are vulnerable.
Today, Pennsylvania rural counties are in jeopardy of facing a rapidly escalating addiction problem as COVID-19 continues to increase stressors like anxiety and social isolation that can lead to substance abuse. And, in a state resuming elective surgeries, Pennsylvania’s 46 rural hospitals, with 10 hospitals labeled as vulnerable by the National Rural Health Association, are likely to write a high number of opioid painkiller prescriptions as patients return to hospitals for elective care. Without federal action, this situation will grow increasingly dangerous.
However, the situation can be improved by enacting federal legislation already in the House and Senate. The most effective way to combat our addiction crisis is to expand access to non-opioid pain treatments.
Unfortunately, the Centers for Medicare and Medicaid Services (CMS) have failed to take the necessary steps to make these less-addictive pain treatment options more accessible to patients.
By bundling Medicare’s surgery reimbursement payments, CMS has inadvertently put up a barrier to the implementation of newer, non-opioid pain relief therapies. Because providers are not being adequately reimbursed for safer, opioid-free pain relief alternatives, Medicare patients are frequently not offered these medications when they could be effective. Instead, they are prescribed potentially addictive opioids.
The NOPAIN Act, bipartisan legislation in the United State Congress, would put patients back in charge of their treatment options by expanding Medicare’s coverage for non-opioid pain options. Allowing patients and doctors to select the safest recovery option, rather than worrying about additional Medicare fees, would go a long way to reducing the number of opioids prescribed in our medical facilities, helping stem our nation’s rising tide of addiction facing it.
This legislation is an important part of our country’s response to COVID-19. Passing the NOPAIN Act would help prevent the current pandemic from escalating the ongoing opioid epidemic. Pennsylvania’s congressional delegation should use this opportunity to put patients first and put our state on the path to healing.
Dr. Joseph F. Robare serves as president of the Pennsylvania Rural Health Association. He is an associate professor and MPH Program Director at Slippery Rock University.