Alabama’s Opportunity in Non-Opioid Pain Management
Last year, I suggested pursuing a federal lawsuit regarding an approach that commends Senator Katie Britt, who co-sponsors an important piece of legislation. While it’s essential for federal efforts to expand access to non-opioid treatments for all Medicare seniors, Alabama has a timely chance to enhance access to non-opioid pain management for our community. In the coming weeks, the state Medicaid program will make a decision about how to support non-opioid treatments, which could either prevent addiction or allow it to escalate.
The recent statistics regarding Alabama’s opioid crisis tell a layered story. The state has made commendable advancements, reducing opioid prescriptions from 97.5 per 100 in 2018 to 71 per 100 in 2023, as noted by the CDC. However, it remains with the second-highest prescription rate in the nation. In 2024, opioids accounted for 794 overdose deaths, representing 67.5% of all overdose fatalities. We still have more work ahead, even as we progress. If we can keep lowering opioid prescriptions, it should help mitigate both overdoses and addiction. In my role as CEO of Inside Medicine, I’ve witnessed firsthand how providing patients, doctors, and communities with safer treatment options can significantly influence health outcomes. Therefore, the stakes for Alabama Medicaid’s forthcoming coverage decisions are substantial.
In the southeastern region, several neighboring states have already adopted policies aimed at reducing opioid prescriptions. Louisiana, Tennessee, Florida, Georgia, and South Carolina have all introduced “Parity Access.” This initiative simplifies access for patients seeking non-opioid pain management without navigating excessive bureaucracy. These states understand that it’s cheaper and more effective to prevent addiction than to address it after it manifests. They’ve realized that government should strive to eliminate obstacles to quality healthcare rather than create them.
From an economic perspective, the argument is also compelling. All investments made to dismantle barriers to non-opioid treatments yield substantial returns by avoiding the costs associated with addiction treatment, emergency care, and long-term medical support.
On the other hand, if the Medicaid program opts to impose prior authorization for non-opioid treatments, it might inadvertently pressure patients into dependence on substances that have devastated our communities. Those recovering from surgery or injuries could find themselves in a harsh position, forced to either endure prolonged suffering while awaiting bureaucratic approval for access to opioids or turn to safer pain management alternatives. The FDA has sanctioned non-opioid treatments proven effective for acute pain, but the pre-authorization policy complicates straightforward and safer options. This misguided incentive structure contradicts both medical evidence and common logic.
Faced with this counterproductive situation, Alabama Medicaid officials have clear choices ahead. They can follow the example set by neighboring states by implementing parity access, ensuring that non-opioid treatments are just as easily available as opioids when patients need them. Alternatively, they could maintain prior authorization requirements, likely pushing more Alabamians toward addiction.
People in Alabama tend to favor prevention over unnecessary bureaucracy, valuing long-term wellness over short-term fixes. The fact that so many neighboring states have opted for parity access reflects a growing awareness of the devastation caused by the opioid crisis on both local communities and economies. The possibility of mitigating some of that damage is worth pursuing. Ultimately, the question remains: will Alabama take the lead or delay in protecting its citizens from preventable addiction?
