Misused prescription opioids are a big part of our state’s drug crisis. Four out of five new heroin users come to the drug after abusing painkillers (often shared by or even stolen from a friend or relative). The result: a record number of overdose deaths in Maine last year (most from heroin, prescription painkillers and fentanyl) and tens of thousands of Mainers who want addiction treatment but can’t get it.

Now major Maine insurers are taking laudable steps to shut down this black market. But until and unless doctors and patients have access to options other than opioids for managing pain, this crackdown won’t lead to lasting change.

Responding to efforts by Maine policymakers and public health advocates to put stringent restrictions on the prescription of opioids, companies like Aetna, Anthem and Cigna are implementing policies designed to curb overprescribing, such as warning physicians who prescribe high doses of opioids, investigating signs of doctor shopping and setting goals for reducing prescriptions.

This is the smart thing to do, both for the insurers’ bottom line — painkillers, addiction treatment and ER care for overdoses are all expensive — and the public good. And there’s little evidence to back up the benefits of long-term opioid therapy.

But the insurers’ tactics to fight prescription abuse won’t reduce the number of people in chronic pain — people who may want to avoid opioid painkillers but are having a hard time finding alternatives.

Even though everyone from the Institute of Medicine to the Office of the Army Surgeon General has recommended a model of pain care that doesn’t rely on medication, programs that take this approach are rare, and insurers often balk at paying for their services.

One example is close to home. It’s taken a lot of work to get health plans to cover the program at Mercy Hospital’s Pain Center, which includes exercise therapy, behavioral and cognitive therapy, group sessions and similar pain control techniques, according to the center’s director, Dr. Stephen Hull.

Some services aren’t reimbursed, and Mercy Hospital absorbs the cost so that patients can get the care, Hull said. But in other circumstances, pain patients who don’t want to use opioids have a choice that actually is no choice at all: Suffer or pay up, like the Midwestern mother of three interviewed by the journal Modern Healthcare who opted for physical therapy over Vicodin and wound up spending $40,000 out of pocket.

Reducing the oversupply of prescription painkillers addresses just one facet of the drug crisis in Maine. If insurers want to stem the tide of addiction, they should help make it easier for people to access alternatives to the medications that are being abused.

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