NPR’s Robert Siegel spoke with Dr. Debra Houry, director of the Centers for Disease Control and Prevention’s National Center for Injury Prevention and Control, who’s been involved in the development of the guidelines from the beginning. Every day, more than 40 Americans die from overdoses of opioid painkillers, according to the CDC.
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The CDC recommends non-opioid therapy, including exercise and over-the-counter pain medications, as the preferred treatment for chronic pain.
Almost a decade ago, Purdue Pharma and three former executives pleaded guilty to fraudulently marketing OxyContin as less addictive than other pain medications and paid $634 million in fines. And if a doctor feels an opioid should be used for chronic pain management in a patient, it should be done very thoughtfully and with close monitoring, including urine tests for undisclosed opioid use.
Education Images/UIG via Getty Images The CDC wants a drastic reduction in the use of painkillers which are prescribed to deal with acute and chronic pain. Physicians trained in the 1960s and 1970s amid a wave of urban heroin use were taught to reserve opioids for the most severe forms of pain, such as cancer or end-of-life care.
The 12 recommendations are based on three primary principles: using non-narcotic drugs except to treat active cancer and for palliative and end-of-life care; using the lowest effective dose of opioids; and close monitoring of patients.
The Food and Drug Administration restricted some of the most commonly prescribed painkillers to limit refills.
What should doctors tell people who suffer chronic pain and are on opioid therapy now?
In order to curb opioid overdose and abuse of prescribed painkillers, the United States Centers for Disease Control and Prevention (CDC) on Tuesday issued voluntary guidelines directing doctors to avoid prescribing opioids for chronic pain.
The CDC hopes the guidelines will help doctors determine when to begin or continue opiates for chronic pain, which type of painkiller to choose, how long to administer the drugs and how to weigh their risks. “The risks are addiction and death, and the benefits are often transient and unproven”, Frieden said.
Primary care doctors write about half of the opioid prescriptions.
The guideline is created to improve decision-making when prescribing pain medication. We see that there is an increased risk of auto crashes, death from overdose. “The guideline will give physicians and patients the information they need to make more informed decisions about treatment”. Since 1999, the amount of opioids prescribed in the US has quadrupled, though the amount of pain reported by Americans has not changed.
“For the first time, the federal government is communicating clearly that the widespread practice of treating common pain conditions with long-term opioids is inappropriate, because the risks clearly outweigh the benefits”, said Kolodny, a senior scientist with the Heller School for Social Policy and Management at Brandeis University.
Changing medical practice isn’t quick and it isn’t easy.
Telling patients and doctors that opiates are rarely needed for more than a few days “will help prevent patients from getting addicted and help keep highly addictive drugs from accumulating in medicine chests”, Kolodny said.
“Just as we need rules of the road to prevent injury and death, we need strong guidelines that can help prevent abuse of and addiction to opioid painkillers”, Markey said in a statement.
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“Rates of opioid prescribing vary greatly across states in ways that can not be explained by the underlying health status of the population, highlighting the lack of consensus among clinicians on how to use opioid pain medication”, the authors note.
