Chronic Pain and Addiction Treatment in Nebraska

How is chronic pain treated when someone also has a substance use disorder?

When someone in Nebraska has chronic pain and a substance use disorder, care usually follows one shared plan, with the pain clinician and the addiction clinician talking to each other instead of acting separately. Which options fit, such as buprenorphine, non-opioid medicines, physical therapy or talk therapy, is a decision for the person and their clinicians.

Nebraska’s Heritage Health plans bring physical health, behavioral health and pharmacy together, which can make that coordination easier for Medicaid members to arrange. Being on long-term pain medicine is not the same as having an addiction, and intake staff should ask questions to tell the two apart.

Physical dependence, where the body adjusts to a medicine and reacts when it stops, differs from a substance use disorder. Quickly cutting or stopping a long-term opioid or benzodiazepine prescription without help is unsafe, because withdrawal and rebound pain can follow, so any reduction should be planned with the prescriber.

Methadone comes only through licensed opioid treatment programs, while buprenorphine is offered more widely through clinics and office practices. Ask whether the program, once you give written consent, will talk with your pain prescriber before any medicine is changed. Telehealth can cover some follow-up across rural Nebraska, although physical therapy and other hands-on care still require going in person.

Is it safe to stop or reduce pain medication on my own?

Stopping or quickly cutting a long-term opioid or benzodiazepine prescription on your own is not safe, so plan any reduction with the prescriber. A sudden stop can bring withdrawal and a rebound in pain, and stopping benzodiazepines abruptly can cause seizures. Benzodiazepines are not a pain treatment, and taking them with opioids raises the risk of dangerously slowed breathing. Nebraska programs listing benzodiazepine treatment can explain how a supervised taper is planned.

Nebraska law lets pharmacists and other health professionals dispense naloxone to people at risk of an opioid overdose and to their family and friends. Naloxone is also sold over the counter. The state health department publishes a statewide opioid overdose standing order. The 2017 Good Samaritan law protects a person who calls for help during an overdose and then stays and cooperates with responders. It also protects the person overdosing, and both are shielded from drug possession charges.

Can I keep getting pain treatment while in addiction treatment in Nebraska?

Pain care can usually continue during addiction treatment, as long as both clinicians know about each other and agree on the plan. Ask the admissions team whether the program will contact your pain prescriber, with your written consent, before any medicine changes. Methadone is given only through licensed opioid treatment programs, found among methadone clinics in Nebraska. Buprenorphine is offered more widely, through suboxone clinics and office practices. Outpatient programs let people keep working and seeing their pain doctor.

Distance is a real factor in Nebraska, where about two in five pain and addiction listings are rural. Nebraska Medicaid does not require in-person contact for covered services and pays for telehealth at least at the in-person rate. Some follow-up may therefore happen through telehealth programs, though hands-on care such as physical therapy still means an in-person visit.

How do I pay for pain and addiction treatment in Nebraska?

Nebraska Medicaid, run through the Heritage Health managed care program, is the main public way to pay for those who qualify. Expansion took effect October 1, 2020, and adults covered under it are enrolled in Heritage Health Adult. Plans are offered by Nebraska Total Care, Molina Healthcare of Nebraska and UnitedHealthcare Community Plan. Ask your plan how it covers medication for opioid use disorder, pain management visits and each level of care, then compare programs that accept Medicaid.

People with private insurance can ask three things. Are substance use benefits covered on terms similar to medical benefits? Are the pain specialist and the addiction program both in network? What prior approval is needed?

Without coverage, the Division of Behavioral Health at the Nebraska Department of Health and Human Services funds treatment through six behavioral health regions, from Region 1 in the Panhandle to Region 6 in metro Omaha. State-funded programs are listed separately. Options are generally more plentiful around Omaha and Lincoln than in the west.

What should I ask a Nebraska program before starting?

Before starting, ask a Nebraska program three questions. Does it treat pain and substance use together? Can it continue or start medication for opioid use disorder? Will it coordinate with your pain prescriber? Each Nebraska listing on RehabSeekers.com shows what the provider reports about chronic pain services, medication for opioid use disorder, levels of care, payment types, insurers, accreditation, languages, populations served and location. People with a co-occurring mental health condition can also check dual diagnosis listings. Opioid-focused programs are gathered under opioid rehab in Nebraska.

Free starting points include the Rural Response Hotline at (800) 464-0258. For families concerned about a young person, the Nebraska Family Helpline at (888) 866-8660 is open 24/7. The national treatment referral line can suggest programs anywhere in the country, and anyone in crisis can call or text 988. The national pain and addiction guide and the Nebraska locations page show more options.