What Will Opioid Users Treating Mesh Pain Do If CARA Becomes Law?

Jane Akre
May 31, 2016
Jade R graphic

Jade R graphic

Update on Opioid Prescription Legislation which will affect users experiencing mesh pain!

Mesh Medical Device News Desk, May 31, 2016, by Still Standing ~ I have periodically tried to update you on what is being done in Congress to impact how opioid and opioid-type prescriptions are dispensed, so here is a quick look at HR. (House of Representatives) 953 and S. (Senate) 524 bills. The official title of the act is the Comprehensive Addiction and Recovery Act (CARA).

Still Standing graphic

Still Standing graphic

The Act was just passed out of a House committee with some amendments, but this is significant because if the Senate passes a bill, the House has to provide the funding and there is plenty of approved spending in this bill. This bill stands a good chance of being enacted because there is bipartisan support and it is an election year. The name of the bill sounds harmless enough and one that most people would say “sure, we need this program.” Who would say they are against preventing opioid addiction?

However, unfortunately, all people who use opioids for chronic pain management have been swept into this over-reaching bill.

It was introduced to address the high rate of heroin, prescription drug and opioid addiction, which has sharply increased in the past five years. New Hampshire has been particularly hit hard. They do need help, no doubt. However, if you go the govtrack.us website and read the summary of the bill, there is NO place in the summary that talks about how this will impact people who have chronic pain conditions and who have good pain management using opioids.

holding hands

Here are the summary points:

  • Allow naloxone to be prescribed with opioid prescriptions
  • Improve prescription drug tracking programs in each state
  • Treating people with addiction who are incarcerated
  • Prohibit the department of education from asking about the conviction from possession or sale of illegal drugs on the Federal Student Aid (FASFA) form

However, there are many things written in the 128-page document that are significant to people with chronic pain. So, here are the take-away highlights from the 128-page funding bill passed in the House committee that will have significant impact on physicians who prescribe even appropriate levels of pain medication to manage pain and what options will be best practice for treating patients.

Many of these regulations seem to group those with chronic pain with those who have addictions. An interesting new label in this act is the term “opioid use disorder.”

Opioids, FDA

Opioids, FDA

This applies to people who are opioid dependent and pertains to any drug that is opioid, opioid-like or potentially addictive. I have read the bill multiple times and still can’t figure out how they will determine if someone who uses opioids for chronic pain will be classified as having an opioid use disorder. It is loosely defined as a person who has developed a dependency or addiction to opioid prescriptions based on the brain chemistry that occurs with these drugs. But, basically, if you have taken opioids for pain, you do have an altered brain chemistry. Physicians who treat people with opioid dependency must go through at least 8 hours of training on opioid use disorder in order to be a qualifying practitioner under this act. They will also be required to obtain a written agreement from each patient, signed by the patient, that the patient will receive and initial assessment and treatment plan, will be monitored for medication adherence and substance use, is informed of all treatment options, and they understand that regular counseling services is critical to “recovery.”

While this still sounds like a good plan, treating people with chronic pain seems to be only a peripheral concern. The American Academy of Family Physicians (AAFP) sent a letter to Congress on March 1, 2016 with the following concern:

American Academy of Family Physicians logo

“The CARA (Comprehensive Addiction and Recovery Act) provision to require the Pain Management Best Practices Inter-Agency Task Force (created by this ACT) to impose so-called ‘best practices’ on receiving and renewing registrations for prescribing medications regulated under the Controlled Substances Act raises very serious concerns. The AAFP opposes action that limits patients’ access to pharmaceuticals prescribed by a physician using appropriate clinical training and knowledge. Family physicians and other primary care clinicians play a vital role in effective pain management, which could include the prescribing of opioid analgesics. The creation of additional prescribing barriers for primary care physicians would limit patient access when there is a legitimate need for pain relief.”

The link to the full text of this letter is here. The Academy supports all of the other sections of the bill. The Task Force will be made up of many government agency appointees and must include one person who has chronic pain. Wow.

One funding part of the bill is that states can apply for funding to put in place a surveillance system that can be accessed by physicians and other medical providers that will track your opioid use. Physicians will be required to access this system before they prescribe opioid or other habit forming drugs.

Insurance companies are also jumping on the opioid bandwagon. Cigna has already introduced an initiative that “flags” customers who are determined by them to be high risk. These are patients who take large quantities of pain medications or those who are filling pain medication through several different doctors.

The article, available here , says that the insurance carrier will consider refusing to pay for opioid medications for patients who fall under this high risk category. A big concern just from thinking this through is what medical credentials will the insurance company employees have when they decide that a customer is high risk? What recourse will patients have to become “un-flagged” as high risk if they feel that they have been unfairly labeled?

CARA does mention alternative pain management methods such as cognitive behavior therapy and complementary and alternative medical alternatives. However, it is important to understand that these interventions don’t provide immediate relief nor total relief. It takes time to learn to apply the skills needed for Cognitive Behavior Therapy to help you. Other interventions such as yoga, physical therapy, mindfulness can certainly help reduce the experience of pain. So, what should women with mesh do to insure that they are not a victim of the fallout of this bill?

Talk to your physician NOW! Ask him or her if you would be considered as high risk under this bill and if so, how will that impact your pain management plan? It is vitally important that you have this conversation before the heavy hand of the government comes down squarely on your very personal pain experience. This will become law. Be educated. Be prepared.


If you are interested in keeping track of this legislation go to:


What are Opioids?

Painkillers That Could Actually Cause Chronic Pain, PsyBlog, May 31, 2016


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