In response to the prescription painkiller epidemic that has swept the nation in recent years, which has fed into the surge in addiction rates and the hundreds of thousands of subsequent overdoses, the Centers for Disease Control and Prevention approved a set of guidelines that will help doctors determine the necessity of opioid painkillers for their patients and approach their prescription practices with greater caution. These guidelines include advice about safe dosages, how to determine the risks and benefits of prescribing opioid painkillers on a case-by-case basis, when/how to prescribe the potent drugs, and how to formulate an effective treatment plan for the patient.
The Prescription Painkiller Epidemic
Prescription opioids such as Oxycodone, OxyContin, Vicodin, Percocet, and Fentanyl are often prescribed to treat patients suffering from physical pain. An estimated 20% of patients that complain of noncancerous pain symptoms or acute and chronic pain receive a prescription for one of these drugs. Prescription opioids are extremely dangerous due to the risks of overdose and dependency. In 2012 alone, doctors wrote 259 million prescriptions for painkillers, which is equivalent to one bottle for every adult in America. Opioid overdose death rates have reached a record high in the United States. Sales of and overdose deaths involving prescription opioids have both quadrupled in since 1999. In 2013, an estimated 1.9 people were dependent on or abused prescription opiates, while more than 28,000 people died from overdoses related to these drugs in 2014. As many as 1 in 4 people that have received long term prescriptions for opioid painkillers for pain unassociated with cancer suffer from addiction, and over 1,000 people are treated in emergency rooms every day for abusing the drugs. CDC director Thomas Frieden stated that the CDC “knows of no other medication routinely used for a nonfatal condition that kills patients so frequently”. This epidemic is primarily due to the careless, unsafe, and/or unnecessary prescribing practices on behalf of medical professionals, as Frieden reinforced when he announced that “the prescription overdose epidemic is doctor-driven”, and needs to be addressed at the source. The approval of these guidelines will serve as a means of educating doctors about safe prescribing practices, communicating effectively with patients, and discussing healthier alternatives for the treatment of different kinds of pain.
The Guidelines
Due to the fact that the CDC is not a regulatory agency, the guidelines they presented are just those; guidelines, which means they are not mandatory and cannot be enforced by the CDC. However, directives such as this one have proven to be effective and influential within the medical community in years past. The executive director of Physicians for Responsible Opioid Prescribing, Andrew Kolodny, believes that doctors are likely to follow these guidelines because “for the first time, the federal government is communicating clearly that the widespread practice of treating common pain conditions with long-term opioids is inappropriate” and “the CDC is making it perfectly clear that medical practice needs to change because (doctors) are harming pain patients and fueling a public health crisis”.
The guidelines highlight the addictive nature of such prescriptions, and recommend utilizing other forms of treatment such as different kinds of physical and mental therapy or non-steroidal anti-inflammatory drugs such as ibuprofen or aspirin, at least at the beginning of treatment for those not receiving cancer treatment or end of life care. Additionally, these guidelines recommend communicating with patients about their expectations and educating them about the risks of taking prescription opioids. If prescribing these drugs is discovered to be the most effective course of action in certain cases, the guidelines recommend starting at the lowest possible dose of short-acting opiates as opposed to long-acting opiates. The importance of examining the long-term treatment plan is key as well, and there needs to be a plan in place about how and when to terminate the use of these drugs. Additionally, the CDC recommends that clinicians explore their patients’ histories of controlled substance prescriptions in order to determine whether or not they are on medications that should not be taken in combination with opioids or if they are potentially at risk of abusing or selling their prescriptions. Patient drug tests are recommended as well to ensure that the medication is being used appropriately and that the patient is not abusing other illegal drugs or non-prescribed controlled substances, which may suggest that he or she is struggling with a substance abuse disorder. The underlying goal of these guidelines is to identify whether or not opioid pain medications are necessary in different cases, how to safely prescribe different opioid drugs if they are, and how to ensure that patients are aware of the potential risks and benefits of taking these prescriptions.
The Future
These guidelines offer hope for the nation due to their potential to significantly reduce addiction rates, save lives, and improve the health of countless families and individuals. Gary Mendell, the founder and CEO of Shatterproof, the national non-profit organization focused on ending addiction, believes that now that physicians all over the nation will have access to consistent, reliable information about prescribing opioid painkillers safely, “the CDC should now embark on a sustained effort to have them implemented.” Mendell believes that Doctors should be required to complete training based on these guidelines before obtaining a license to prescribe controlled substances. Regardless of whether or not training according to this information becomes mandated and the suggestions outlined in the report become enforced, the presence of these guidelines will most likely make a marked difference within the medical community and serve as an effective step in addressing the prescription painkiller epidemic that has plagued the nation and continued to escalate in recent years.
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