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  • Angelarosa G. DiDonato, DNP, CRNA

Medicare payments favor opioids over alternatives, and that’s a problem

By Angelarosa G. DiDonato

Our country in struggling with an opioid epidemic. An estimated two million Americans suffer from opioid use disorder, and opioid overdoses kill more than 130 Americans each day, on average.

Studies show that opioid addiction can occur from the very first exposure --- and sometimes, that first exposure may be during anesthesia for a necessary surgical procedure.

Certified Registered Nurse Anesthetists (CRNAs) operate in every setting where anesthesia is administered: hospital operating and delivery rooms; ambulatory surgical centers; the offices of dentists, podiatrists, ophthalmologists, and plastic surgeons; pain management centers and more. With such widespread influence among so many health-care settings, CRNAs play a major role in curtailing the opioid epidemic. We understand the risks and effects of the medications we administer, which is why we’re changing the way we operate. Nurse anesthetists today can manipulate their anesthetic to provide narcotic-sparing and often narcotic-free anesthesia. Our nation’s health programs should be doing the same. Unfortunately, federal regulations from the Centers for Medicare and Medicaid Services (CMS) fail to address a number of outdated regulations that put Pennsylvania’s pain patients in harm’s way. Over the last decade, many non-opioid pain treatment options have been developed, including single-dose injectables that release slowly over the course of up to 90 hours. For many patients, these promising alternative therapies can take the place of traditional more-addictive opioid painkillers. However, CMS rules fail to adequately cover the cost of administering these medications, leaving Pennsylvania’s more than 2.7 million Medicare beneficiaries without the option of affordable, non-addictive pain treatment. In a decade that saw drug overdose deaths skyrocket across the nation, Pennsylvania was among the worst in mortality increases, according to the U.S. Centers for Disease Control and Prevention. Last year, 4,125 Pennsylvanians died, according to the state Department of Health, and two-thirds of those deaths involved opioids. Recently, drug overdoses have spiked in Pennsylvania, with the rise coinciding with stay-at-home orders brought on by COVID-19. Treatment centers closed and counseling and support-group sessions went online. The stress and social isolation of being stuck at home also created a dangerous environment for those suffering from opioid use disorder. Beyond the human toll, the costs of opioid addiction are staggering. The CDC estimates the misuse of opioids costs our nation $78 billion annually in lost productivity, health-care services, addiction treatment, law and justice, and much more. Making alternative treatments more affordable and accessible can make a big difference. National studies suggest a 10 percent reduction in surgery-related opioid prescribing will result in 300,000 fewer people annually developing an opioid addiction, and keep over 330 million opioid pills out of American households, where they are often stolen or abused. These aren’t just numbers on a page --- they speak to lives saved, families preserved, and bright futures kept intact. Given the very real risks of opioid medications and the severity of Pennsylvania’s addiction crisis, we can’t wait to act. Antiquated federal regulations have helped to create our nation’s over-reliance on opioids, which remain the cheapest option for health-care providers because of how insurance payments are administered under the current Medicare reimbursement rule. The federal NOPAIN Act, which has bipartisan congressional support, would change that by requiring Medicare to cover non-opioid treatment alternatives for all Medicare recipients. It’s as simple as that. As a nurse anesthetist who specializes in anesthesiology and non-opioid therapies, I’m worried. I know all too well that legal opioid prescriptions and an over-reliance on pain management with narcotics too often can lead patients down a path of years-long addiction. There is only so much I can do in the operating room. We need help fixing laws that discourage alternatives to have a fighting chance. Passing the NOPAIN Act is a critical step in combatting the addiction epidemic nationwide and deserves our support. Angelarosa DiDonato, DNP, CRNA is president of the Pennsylvania Association of Nurse Anesthetists, online at


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