Physicians told to think twice before prescribing opioids

Painkillers need to be controlled, CDC advises

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In an effort to reduce the number of opioid-related overdoses, the Centers for Disease Control and Prevention on Tuesday issued new recommendations for prescribing opioid medications for chronic pain — excluding cancer, palliative and end-of-life care.

The CDC put together these guidelines, said Dr. Tom Frieden, director of the CDC, as part of the federal government’s response to the sharp increase in heroin- and opioid-related overdose deaths.

Frieden and Health and Human Services Secretary Sylvia Burwell spoke to reporters about the initiative during a media call Tuesday.

“The opioid epidemic is one of the most pressing issues today,” Burwell said. “Last year, more people died from drug overdoses than car accidents.”

The CDC’s 12 guidelines — which offer specific information on dosage, duration, and when and how to reassess progress — are the latest effort from the Obama administration to beef up resources to battle the heroin epidemic. Last week, HHS gave $94 million to 271 health centers in 45 states, including Iowa, to expand substance-abuse services, with a specific focus on treating opioid use.

President Barack Obama also proposed $1.1 billion in new funding in his 2016 budget to address the prescription opioid abuse and the heroin epidemic.

The number of opioids prescribed and sold in the United States has quadrupled since 1999, the CDC said Tuesday, while the overall amount of pain reported by Americans hasn’t changed. What’s more, the CDC estimates that more than 40 people die every day from overdoses involving prescription opioids.

Reliance on prescription painkillers has fueled the heroin epidemic, experts said, which is cheaper and more accessible.

The guidelines — intended for primary care physicians — provide recommendations on the use of opioids in treating chronic pain, or pain that lasts longer than three months. The CDC hopes they will improve communication between clinicians and patients, as well as provide more effective care.

Among the guidelines were:

• Physicians should not prescribe opioids as the first line of treatment. Clinicians should consider opioid therapy only if expected benefits for pain and function are anticipated to outweigh risks to the patient.

• When opioids are used, physicians should prescribe the lowest possible effective dosage for a short time. The CDC said three days or less often will be sufficient, and more than seven days rarely will be needed.

• Providers should closely monitor all patients prescribed opioids.

The guidelines are meant to be a flexible tool, Frieden said.

“The best treatment is not always the most immediate one but the most effective over a long period of time,” he said, adding that has not always been the thought in the past. “We’re now paying the price.”

Painkillers have a role

Dr. Stan Mathew, UnityPoint Health-St. Luke’s Hospital Physical Medicine and Rehabilitation medical director, said the new CDC guidelines are likely to be beneficial for primary care providers. But he worried they also could contribute to a climate where doctors are getting more nervous to prescribe painkillers.

That’s because a small percentage of physicians — often in larger, urban areas — are overprescribing painkillers.

“Doctors don’t want to lose their license,” he said. “Painkillers do have a role in patient care. And it needs to be in a controlled, safe environment.”

But not everyone with back pain needs a painkiller, he said, and it’s important to identify the root of the pain and refer the patient on to specialists for other forms of treatment, such as physical therapy.

Some statewide efforts already are underway to clamp down on overprescribing of painkillers, Mathew noted, including the Iowa Prescription Monitoring Program, which started in 2013 and gives health care providers information regarding patients’ opioid prescription use.

The database contains controlled-substance dispensing information from Iowa pharmacies from 2009 and will maintain records for four years following the date of dispensing.

The Iowa Board of Medicine and health systems also require doctors to take continuing medical education in the areas of prescription painkillers, he said.

“I’ve had patients on a very high dosage that was inappropriate for them,” Mathew said. “So part of their treatment was to work them off that dosage. But I’ve also had people who were severely undertreated.”

The stats

• 40 — More than 40 people die every day from overdoses involving prescription opioids

• 165,000 — Since 1999, there have been more than 165,000 deaths from overdoses related to prescription opioids

• 249 million — The number of opioid pain medication prescriptions written by health care providers in 2013

• 2 million — The number of Americans aged 12 and older who abused or were dependent on prescription opioids in 2014

Source: Centers for Disease Control and Prevention

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