In successfully fighting opioid abuse, KY is failing patients who need pain care | Opinion
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- Kentucky cut overdose deaths by 30% in 2024 through expanded treatment access.
- Insurance hurdles block patients from proven multimodal and opioid pain therapies.
- Physician urges insurers to ease access rules for comprehensive pain care options.
As a doctor treating patients in Kentucky’s opioid crisis, I’ve seen amazing progress—and a problem that’s working against our success.
Kentucky turned things around on overdose deaths last year, cutting them by 30% after losing 1,984 people in 2023. This didn’t happen by luck. We invested in what works: distributing 160,000 Narcan doses, putting nearly 97,000 overdose reversal kits in communities, expanding access to medication treatment for opioid use disorder, and adding 50% more addiction treatment beds since 2019. We now lead our region with more treatment beds — nearly double that of any surrounding state.
But here’s the problem: while we’ve done considerable work for patients with opioid use disorder, we’re failing patients who need pain care.
We know evidence-based multimodal pain management works — everything from physical therapy and cognitive behavioral therapy to interventional procedures, new non-opioid medications, and in some cases, opioids. Yet insurance companies block access to these very treatments. They make doctors fill out endless paperwork, require patients to try cheaper treatments first, or just say no to coverage.
Additionally, they pose limits on opioid access with strict formulation, dose, and quantity rules. What happens? Patients get stuck in a system that offers neither good non-opioid options nor proper opioid care when needed. Without access to non-opioid pain treatments, doctors are forced to rely only on opioids until they abruptly stop prescribing for a variety of reasons, including insurance limits. When my patients can’t get therapy, integrative medicine, proper opioid care, or non-opioid pain treatment options, some self-medicate and turn to drugs. Others suffer in silence, losing trust in healthcare entirely. This isn’t just poor medicine — it’s dangerous policy that undermines everything we’ve accomplished.
We’ve proven that recovery works when people can get the care they need. Kentucky’s success shows what happens when we remove barriers instead of creating them. So why do we accept a system that makes pain treatments harder to get?
The 1,984 Kentuckians we lost deserved every option to heal safely. The thousands more still struggling with pain deserve the same. We can’t afford to maintain barriers between patients and appropriate treatments.
Insurance companies can be part of Kentucky’s success story by taking three steps: First, stop requiring endless paperwork for proven pain treatment. Second, cover both new non-opioid drugs and proper opioid access for severe conditions like cancer. Third, remove limits on how long or how often patients can get treatment.
The question isn’t whether we can afford better access—it’s how fast we can remove every barrier between people and the pain treatments that can improve or even save their lives.
Katrina Nickels is a palliative care and addiction medicine physician in Kentucky. The views expressed are her own and do not represent the views of her employer nor any affiliated organizations.