Breaking down barriers: Why Indiana’s pain management po

During my 30 years in the Indiana Senate, I witnessed numerous pieces of legislation aimed at toughening our drug policies and penalties.

In my final years, I authored a series of bills that focused on assisting those struggling with addiction. This occurred at the height of the opioid crisis.

I began to change my perspective when I understood more clearly that addiction is a disease, not a character flaw. The opioid crisis transformed how I view addiction and those affected by it.

The mothers, fathers, grandparents, and teenagers who became addicted to opioids did not meet a dealer in a back alley; instead, they went to a pharmacy and filled a legal prescription for opioid-based pain medication. Unknowingly, they took the medication and developed an addiction.

Then the addiction took control, ruining their lives, families, careers, and futures. Today, we have a greater understanding of the addictive nature of opioids, which has helped to reduce prescriptions, yet opioids remain the only treatment option available for some conditions. Thankfully, more and more non-opioid pain relievers have been approved by the FDA and are entering the market.

Indiana has made remarkable progress in reducing overdose deaths. CDC data shows that our fatal drug overdoses dropped by 17% from 2022 to 2023, marking the sixth largest decrease nationwide.

However, thousands of Hoosiers continue to die, with preliminary data indicating 2,089 drug-related deaths in 2023, primarily due to opioids. Indiana has confronted opioid addiction directly, and Gov. Mike Braun, along with FSSA Secretary Mitch Roob, has demonstrated true leadership in tackling opioid abuse.

Still, there is one more step they can take to revise policies that may be inadvertently guiding doctors toward prescribing opioids when alternative treatments are available.

There is an administrative reality that many policymakers are likely unaware of currently.

Our bureaucratic system directs doctors to prescribe opioids. How? A premium is placed on our physicians’ time as they strive to see more patients. Anything that takes up that valuable time and isn’t related to healing is considered wasted, and our current system rewards physicians by prioritizing efficiency. The truth is that safer non-opioid alternatives require more insurance approvals and prior authorization, and there’s still a chance they won’t be approved, leaving the patient to continue suffering pain.

When a patient is in pain, medical professionals must navigate numerous obstacles to prescribe safer non-opioid medications, yet they can prescribe opioids with minimal paperwork.

Guess which one they will choose?

This isn’t a matter of doctors being lazy; it reflects the current reality of practicing medicine, where administrative tasks take up a considerable amount of time and can hinder patients from receiving the treatment they need.

Other states are addressing this problem. Tennessee and Georgia have successfully implemented policies that expand access to non-opioid pain management options by reducing administrative barriers.

These states recognized that insurance policies shouldn’t inadvertently promote opioid use, and they’ve taken meaningful steps to level the playing field. Indiana should do the same.

Earlier this year, the Indiana General Assembly had brief discussions to require equal treatment of non-opioids and opioids in both Medicaid and commercial insurance plans. Unfortunately, the discussion never reached legislative consideration.

Thankfully, we don’t have to wait until the legislature convenes again in January. Gov. Braun and Secretary Roob can make the administrative changes through executive power to eliminate or reduce prior authorization requirements for FDA-approved non-opioid pain treatments, streamline the approval process for evidence-based alternatives, and bring non-opioid options in parity with opioid options in terms of administrative burden.

Instead of trying to break the opioid addiction cycle after a person becomes addicted, we need to focus on preventing it from happening in the first place. By removing barriers to safer, non-addictive alternatives, we can encourage doctors to make decisions based on their medical training, not what they think insurance will accept.

The path ahead is clear. With focused administrative adjustments, Indiana could serve as a model for aligning insurance policies with public health objectives.

We’ve demonstrated our ability to reduce overdose deaths.

Now, let’s ensure we’re not unintentionally creating new addictions through well-meaning but misguided insurance barriers. Every patient deserves access to the safest and most effective pain management options, without bureaucratic hurdles obstructing their path.