By: Dr. Ken Teufel
Think twice before writing that prescription for a pain-relieving opioid. That's the clear, strong message from the CDC in its attempt to curb the growing "epidemic" of pain killer abuse and opioid-related deaths. According to CDC Director Tom Frieden, M.D., sales of opioids such as Vicodin, Oxycontin, and Percocet have quadrupled since 1999, accounting for 165,000 fatal overdoses during this time period, and now the cause of 40 deaths per day.
In an NBC news interview, Frieden said he was "stunned" to learn that "one out of every 32 patients given the highest doses of opiate drugs would die within two and a half years." More than 70 percent of patients who die from opioid-related deaths became addicted while being treated for chronic pain.
"The prescription overdose epidemic is doctor-driven," says Frieden. Nearly half of all opioid prescriptions are written by primary care physicians for treatment of chronic pain in outpatient settings.
In most cases, doctors are simply trying to do what's best for their patient, not wanting to be criticized for providing inadequate pain relief. Based on interviews, "primary care clinicians report having concerns about opioid pain medication misuse, find managing patients with chronic pain stressful, express concern about patient addiction, and report insufficient training in prescribing opioids."
The voluntary guidelines recently released by the CDC address these concerns, emphasizing that "the risks [of prescribing opioids] will outweigh the benefits for the vast majority of patients."
Physicians also need to recognize that "the best treatment isn't always the one that provides the most immediate relief," and being 100 percent pain-free may not be a realistic or even a desirable goal.
Instead of prescribing "habit-forming" opiates, non-addictive pain medication such as acetaminophen or ibuprofen will be equally effective for many patients, especially when combined with non-drug pain control measures like physical therapy and targeted exercise programs.
"If you're prescribing an opiate to a patient for the first time, that's a momentous decision," says Frieden (The Wall Street Journal, March 16, 2016). "That may change that patient's life for the worse forever. So you've really got to think carefully before doing it." If it's still determined that an opioid drug is the best choice for pain relief in a particular situation, start with a low-dose and only for a short period of time. According to the guidelines, "three days or less will often be sufficient. More than seven days will rarely be needed for most acute pain syndromes."[The CDC's guidelines apply only to patients 18 years of age and older with chronic pain and excludes patients receiving palliative or end-of-life care.]
To review these guidelines in their entirety, go to: CDC Guidelines for Prescribing Opioids for Chronic Pain, United States, 2016 (Morbidity and Mortality Weekly Report, March 15, 2016).
About the author: Dr. Ken Teufel is the medical director at Interim Physicians, a pioneer locum tenens physician staffing firm based in St. Louis, MO that has provided quality physician coverage to hospitals, clinics and other healthcare facilities since 1979.