Pain Patients Turn To Controversial Injection After Cuts To Opioid Coverage

By Kelly Burch 08/02/18

The anti-inflammatory drug has been banned in Australia, Brazil, Canada, France, Italy, New Zealand and Switzerland.

Patient visiting doctor's office with back pain

Back problems are the most common cause of chronic pain, and at the time when Medicare is cutting coverage for many opioid pain relievers, lawmakers are increasing Medicare coverage for a potentially dangerous off-label treatment for back pain. 

Depo-Medrol is an injectable anti-inflammatory drug made by Pfizer. When it is injected into muscles and joints it can provide pain relief, but the drug is not supposed to be injected into or near the spinal chord. In fact, in 2013 Pfizer asked the Food and Drug Administration to ban back injections.

The FDA declined to issue the ban, despite the fact that Australia, Brazil, Canada, France, Italy, New Zealand and Switzerland all issued bans, according to The New York Times

“Serious neurologic events, some resulting in death, have been reported with epidural injection of corticosteroids,” Pfizer told the FDA. “Specific events reported include, but are not limited to, spinal cord infarction, paraplegia, quadriplegia, cortical blindness, and stroke.”

In June, legislators approved an increase in reimbursements for the Depo-Medrol shot.

At the same time, Medicare finalized a restrictive plan for covering opioids that will make it difficult for all but the most severe patients to access opioids long-term. This combination could make injectables a more appealing treatment, despite their risks. 

“The victims of our era of aggressive opioid prescribing are being exploited in some cases by interventional pain doctors, who will continue them on opioids in exchange for allowing them to perform expensive procedures that they don’t need,” said Dr. Andrew Kolodny, co-director of opioid policy research at Brandeis University and executive director of Physicians for Responsible Opioid Prescribing. “These are not benign procedures. Patients can be harmed and are harmed.”

Despite this, use of Depo-Medrol and similar drugs increased 7.5% among Medicare patients between 2012 and 2016. Dr. James P. Rathmell, chairman of anesthesiology, perioperative and pain medicine at Brigham and Women’s Hospital, said that Medicare coverage policies have the potential to make the shots even more popular. 

“The truth underlying it is that doing an injection is faster and results in higher reimbursements, compared to other ways of managing the same pain,” he said. “The use of injections has increased dramatically, yet the prevalence of back pain has remained relatively unchanged.”

Dr. Brian Yee, an anesthesiologist who practices in West Virginia, said that injections have the potential to be useful, but that they need to be handled carefully in order to ensure that they are being used responsibly. 

“With people trying to take away opioids now, we are opening up another doorway for people to overutilize other options that can be helpful with the right doctors and the right patients,” he said.

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Kelly Burch writes about addiction and mental health issues, particularly as they affect families. Follow her on TwitterFacebook, and LinkedIn.