Opioid epidemic addressed as CDC issue new prescription guidelines
The CDC say the new guidelines should help doctors talk to their patients about how to manage pain in the safest, most effective manner.
The US is in the midst of a prescription drug overdose epidemic. Prescriptions and sales of addictive opioids like Vicodin and Percocet have quadrupled since 1999, yet there has not been an overall change in the amount of pain that Americans report during that time.
The new guidelines from the Centers for Disease Control and Prevention (CDC) – in the form of 12 recommendations – are aimed at primary care doctors treating adult patients for chronic pain.
These primary care outpatient settings account for nearly half of all opioid prescriptions, say the CDC.
CDC Director Dr. Tom Frieden, says that overprescribing of opioids – largely for chronic pain – is driving the overdose epidemic. “More than 40 Americans die each day from prescription opioid overdoses, we must act now,” he notes.
The guidelines will give doctors and patients the information they need to decide the best treatment, he adds.
Chronic pain is pain lasting longer than 3 months or past the time of normal tissue healing.
Prescription recommendations embrace three principles
“While prescription opioids can be part of pain management, they have serious risks,” state the CDC, whose 12 recommendations urge doctors to adopt three principles:
- Promote non-opioid drugs for chronic pain
- If opioids are used, prescribe the lowest possible dose to avoid misuse and overdose
- Exercise caution when prescribing opioids and monitor all patients closely.
For example, in the case of the second principle, the CDC note that long-term opioid use “often begins with treatment of acute pain,” and urge doctors to prescribe “no greater quantity than needed for the expected duration of pain severe enough to require opioids.”
“Three days or less will often be sufficient; more than seven days will rarely be needed,” the CDC suggest.
The new guidelines do not apply to cancer treatment, palliative care or end-of-life care.
The CDC say that they followed a “rigorous scientific process using the best available scientific evidence” to develop the guideline, and they also invited comments from the public and partner organizations.
Increased non-medical use of opioids linked to heroin
Abuse of and addiction to opioids like heroin, morphine and prescription pain medication is a huge global health problem, with an estimated 26-36 million people abusing opioids worldwide.
Estimates for 2012 suggest that 2.1 million Americans suffer from substance use disorders linked to prescription opioid pain relievers, with an estimated 467,000 addicted to heroin, said Dr. Nora Volkow, Director of the National Institute on Drug Abuse, in her testimony to Congress in May 2014.
“There is also growing evidence to suggest a relationship between increased non-medical use of opioid analgesics and heroin abuse in the United States,” she noted.
The CDC’s new guidelines come less than a week since the Senate passed legislation to fight the growing epidemic of painkiller and heroin abuse. The legislation signifies a major shift from punishment toward rehabilitation.
The bill includes, for example, provision to establish education programs, help veterans with addiction and give officials tools to lower the death rate from overdose. It also aims to provide states with incentives to make naloxone more widely available.
Naloxone is an opioid overdose antidote that, according to the CDC, reversed more than 10,000 overdose cases between 1996 and 2010.
To help doctors and patients make informed decisions about treatment of chronic pain, the CDC have issued a collection of leaflets, including a decision checklist, to accompany the new guidelines.
Dr. Debra Houry, director of CDC’s National Center for Injury Prevention and Control, says:
“Doctors want to help patients in pain and are worried about opioid misuse and addiction. This guideline will help equip them with the knowledge and guidance needed to talk with their patients about how to manage pain in the safest, most effective manner.”
Meanwhile, Medical News Today recently learned how researchers are investigating the potential use of tarantula venom to fight chronic pain.