Earlier this month, the Center for Disease Control (CDC) released new guidelines for prescribing opioids for chronic pain in an effort to lessen widespread abuse of opioids.
Opioids are a class of drugs that include a number of illicit drugs, as well as prescription pain relievers like oxycodone, hydrocodone, codeine, morphine, and fentanyl. These drugs interact with opioid receptors in the brain to produce pleasurable effects and relieve pain. They are known to be highly addictive. In 2014, 1.9 million Americans had a substance abuse disorder that involved pain relievers.
Drug overdose is the leading cause of accidental death in the United States. In 2014, 18,893 deaths were attributed to accidental overdoses of pain medication. Such rampant abuse may in part be due to the extensive availability of these drugs; in 2012, 259 million prescriptions for opioids were written, more than enough prescriptions to give every adult in America a bottle of pills. As many as 1 in 4 patients receiving prescription opioid drugs struggles with addiction.
The new guidelines focus specifically on primary care physicians administering opioid drugs. Primary care physicians treat patients with a wide variety of conditions, and often these patients began using prescription opioids while under the care of a different, specialty doctor.
The new guidelines are not required, but they offer twelve recommendations to physicians including:
Use nonopioid treatment
The CDC recommends that opioids should not be used until other options are exhausted. The CDC cites studies showing that nonopioid pain relievers are just as effective but are less harmful in the long run and are not as addictive.
Review prescription drug monitoring data
PDMPs are databases of information about prescription drug use. Doctors should check these databases regularly, both before prescribing opioids and repeatedly during a patient’s treatment to monitor new statuses. Studies have found that patients with one or more risk factors for overly high dosages account for 55% of all overdose deaths.
Offer treatment for opioid use disorder
A study found that patients prescribed high dosages of opioids long term (over 90 days) have 122 times the risk of opioid use disorder compared to patients not prescribed opioids.
Start low and go slow
The CDC advises physicians to start opioid prescriptions with the lowest possible dosage. Doses over 100 MME/day are associated with 2 to 9 times the risk overdose compared to doses of less than 20 MME/day.
Avoid concurrent prescribing
The CDC notes that opioids prescribed concurrently with benzodiazepines are associated with a quadrupled risk of overdose death compared to opioid prescription alone. Benzodiazepines are drugs used as muscle relaxers, sedatives, and anti-anxiety. Common brand names include Valium, Ambien, Lunesta, Klonopin, and Xanax.
States will take these new recommendations into consideration, and some will create concrete policy. Though doctors are not required to follow the recommendations, most agree that prescription opioid abuse is a problem that needs to be alleviated.
Before prescribing opioid pain relievers, doctors can try alternative treatments like physical therapy, acupuncture, antidepressants, counseling, and anti-inflammatory drugs. Adapting to the change will also be up to patients who will need to cope with new ways of handling chronic pain.