In an effort to combat the growing epidemic of prescription opioid painkiller addiction, abuse and overdose deaths in the United States, the CDC (Center for Disease Control and Prevention) issued new guidelines urging doctors to stop overprescribing these narcotic painkillers to treat chronic pain because the risks of use greatly outweigh the benefits. The new guidelines, published in JAMA (Journal for American Medical Association), March 15, 2016, openly reject opioids as the “first-line therapy” for chronic pain treatment.
“Chronic pain” is defined as pain lasting longer than 3 months, or longer than expected healing time for an injury or disease. Prescription opioid painkillers include morphine-like narcotics including Vicodin, Percocet, Oxycontin and Oxycodone. These narcotics are frequently prescribed for chronic pain conditions including back pain and arthritis.
The new CDC guidelines implore primary care physicians to first try other modalities and treatment for pain complaints before prescribing an opioid painkiller, including physical therapy, exercise, ice, use of over-the-counter pain medications like Tylenol, Advil or aspirin, or behavioral therapy. If these non-opiate pain relief options fail to relieve a patient’s pain, doctor and patient have a duty to discuss why opiates may be necessary, the risks versus the benefits of using opioid painkillers, the expected outcome from using opiates, and a plan for when to stop using them.
Once opiates are recommended, the CDC further urges the lowest effective dose, for the shortest duration, should be prescribed. Experts believe 3 days or fewer of opiates are appropriate to treat most short-term pain complaints. “Three days or less will often be sufficient. More than seven days will rarely be needed for most acute pain syndromes,” explained CDC Director Dr. Thomas Frieden. Once recommended, doctors should prescribe immediate-release opiates, which are less likely to be abused than extended-relief tablets.
The CDC stressed doctors and patients have a shared responsibility concerning opiates: doctors should not overprescribe opiates and patients should not demand them as a first resort when experiencing pain. For long-term opiate use, doctors should also follow up at 3-month intervals with patients to re-evaluate the risks versus benefits of continued use. Doctors should look signs for abuse or addiction issues, and refer any patient for opiate addiction or abuse treatment if that is suspected.
The CDC guidelines do not apply to doctors treating patients with cancer, those with long-term crippling and painful diseases, or patients in end-of-life treatments, but rather are directed mostly toward primary care physicians who are responsible for prescribing almost 50% of the opioid painkiller prescriptions written each year in the United States. 20% of patients presenting with pain complaints to their primary care physician are given opiates. In 2013, the CDC estimated nearly 2 million Americans were abusing or addicted to opiates, and in 2014 alone, nearly 200 million opioid prescriptions were written. That overprescribing has resulted in more than 40 deaths each day from painkiller overdoses, totaling nearly 47,000 deaths in 2014, and 32,000 more deaths annually than from car accidents.
Unfortunately, the guidelines are not legally binding on doctors since the CDC is not a regulatory agency and has no enforcement authority, but hopefully, these common-sense guidelines will help doctors change their practice behavior when prescribing opioids.