For the first decade of the millennium, the rate of prescription of opiate medications (e.g., OxyContin, Percocet, Lortab, and others) skyrocketed. As a result, rates of prescription drug abuse and addiction skyrocketed as well, and more and more Americans lost their lives to overdose as a result. It soon became clear that painkiller addiction was an epidemic that had infected every part of the country. Law enforcement, the medical community, and government organizations all worked together to create measures that would not only prevent new cases of painkiller abuse and addiction but also identify those currently struggling with the disorder and connect them with treatment.
These measures have had varying degrees of success. Thanks to the implementation of new statewide prescription drug monitoring databases, it has become more difficult to obtain prescription drugs illicitly by fraudulently filling the same prescription at multiple pharmacies or seeking multiple prescriptions for similar substances from different doctors. However, there are still individuals who develop prescription drug abuse problems or addiction after becoming dependent upon a legitimate prescription, or using the pills left over from a family member’s prescription for recreational purposes. Both of these issues can still cause prescription overdose deaths and lives marred by addiction-related issues.
In an effort to directly address the problem of prescription drug abuse at the source, the Centers for Disease Control (CDC) has released draft guidelines for doctors who prescribe opiate painkillers to patients. The guidelines recommend a conservative approach when it comes to determining when a painkiller is necessary in treatment and what dose will be therapeutically effective. It also provides advice for monitoring a patient’s long-term use of addictive medication and how to note the signs of potential abuse as well as how to address that situation effectively.
Will these guidelines make a difference in terms of rates of painkiller abuse and addiction in 2016?
Alternative and Holistic Treatment Options
One of the main emphases in the new CDC painkiller prescription guidelines is the utilization of a range of non-addictive treatment methods for chronic pain management, says The Washington Post. For example, patients may benefit from any combination of the following treatments as a first line of defense against chronic pain:
- Talk therapy that can help to address underlying issues of anxiety and depression that may be triggering or worsening physical pain and discomfort
- Physical therapy that makes use of stretches and exercises to reduce physical stress and pain
- Holistic pain management, like acupuncture and acupressure as well as yoga and meditation, to lower stress and decrease pain
- Herbal and vitamin supplements that address nutrient deficiencies that may be triggering or worsening the experience of pain
- Nutritional therapy to similarly address nutrient deficiencies
- Exercise and personal training to maintain a healthy weight and reduce stress on the joints and associated pain
Conservative Painkiller Prescription Practices
The CDC guidelines also suggest that, if painkillers are deemed necessary, prescribing physicians should:
- Elect the use of short-acting painkillers rather than longer-acting opiates.
- Prescribe the lowest possible dose of any addictive medication.
- Prescribe any addictive painkiller for only a short period of time.
- Require patients to meet with the doctor in person to assess the efficacy of the painkiller and to get a refill.
- Require a drug test prior to beginning a new painkiller prescription to determine whether drug use is a current problem.
- Require recurrent drug tests to ascertain whether illicit drug use or high-dose painkiller abuse has become a problem during the course of treatment.
Additionally, the CDC guidelines note that in the case of acute pain (e.g., after surgery or accident), only three days or fewer “usually will be sufficient for most non-traumatic pain not related to major surgery.”
It should also be noted that these guidelines are not intended to be applied to the treatment of patients at the end of life or suffering from late-stage cancer.
Support Primary Care/Family Physicians
In a study published in the journal JAMA Internal Medicine, it was noted that primary care physicians, or family doctors, prescribe most painkillers in the United States: 15.3 million opiate prescriptions in 2013 as compared to 12.8 million prescribed by internal medicine specialists. Unfortunately, family physicians are not always specifically trained in best practices for painkiller prescription and may not be keyed into the potential dangers or warning signs of drug abuse or addiction. The CDC guidelines may help to address this issue.
Reducing Risk in Chronic Pain Management
Too often, pain patients feel that they are being marginalized and forced to jump through unnecessary hoops in order to get the medication they need to manage chronic pain. The fact is, however, that these laws are put into place to protect them from inadvertently falling victim to a deadly addiction disorder and/or succumbing to overdose.
Accidental overdose on a prescription is a real and present danger. According to the CDC, more than 47,000 Americans lost their lives due to drug overdose in 2014, an increase of 7 percent from 2013. The increase was fueled in large part by abuse of opiate drugs, including prescription painkillers. In fact about 19,000 deaths were caused by painkiller abuse in 2014, an increase from 2013 of 16 percent.
Tom Frieden, the director of the CDC, says: “What we want to just make sure is that doctors understand that starting a patient on an opiate is a momentous decision. The risks are addiction and death, and the benefits are unproven.”