The CDC had waded into the opioid epidemic with new guidelines. Tops on the list: prescription painkillers should not be a first choice for treating common ailments like back pain and arthritis.
Right now powerful drugs like OxyContin and Vicodin are on the front lines of pain treatment, but with the ongoing epidemic of addiction and abuse tied to these powerful opioids drugs, the Centers for Disease Control and Prevention is urging primary care doctors to try physical therapy, exercise and over-the-counter pain medications before turning to painkillers for chronic pain.
Other key takeaways from the CDC recommendations:
- Non-opioid therapy as the preferred treatment for chronic pain outside of active cancer treatment, palliative care, and end-of-life care.
- Prescribing the lowest effective dosage when opioids are used.
- Working with patients to establish pain treatment goals, checking for improvements in pain and function regularly, assessing for risks and benefits, and tapering or discontinuing opioids when risks outweigh benefits.
- Only continue prescribing the drugs if patients show significant improvement.
- For short-term pain, the CDC recommends limiting opioids to three days of treatment, when possible.
The new recommendations — which doctors do not have to follow — represent an effort to reverse nearly two decades of rising painkiller use, which public health officials blame for a more than four-fold increase in overdose deaths tied to the drugs. In 2014, U.S. doctors wrote nearly 200 million prescriptions for opioid painkillers, while deaths linked to the drugs climbed to roughly 19,000 — the highest number on record.
The guidelines do not apply to doctors who specialize in treating severe pain due to cancer and other debilitating diseases.
Though the guidelines are voluntary, they could be widely adopted by hospitals, insurers and state and federal health systems.
Government officials have already tried multiple approaches to tackling painkiller abuse. The Food and Drug Administration restricted some widely-prescribed painkillers to limit refills. States like Florida and New York have cracked down on “pill mills” using databases to monitor what doctors are prescribing. And this week, Massachusetts signed into law a seven-day limit on first-time prescriptions for opioids — the first of its kind in the nation.
The Institute of Medicine (IOM) estimates that there are 100 million Americans living with chronic pain—a number that does not include the additional 46 million individuals the CDC estimates suffer from acute pain due to surgery. So the new guidelines have the potential to affect a large percentage of the population.
The American Medical Association, the largest professional group for physicians, cautioned that the guidelines could create problems if they steer patients toward pain treatments that aren’t accessible or covered by insurance while the American Pharmacists Association came out in support.
Historical Perspective on Opioid Use
In many ways, the guidelines are a return to older medical practice. Physicians trained in the 1960s and 1970s — amid a wave of urban heroin use — were taught to reserve opioids for the most severe forms of pain, such as cancer or end-of-life care. That approach remains accepted.
But in 1990s, some specialists argued that doctors were undertreating common forms of pain that could benefit from opioids, such as backaches and joint pain. The message was amplified by multimillion-dollar promotional campaigns for new, long-acting drugs like OxyContin, which was promoted as less addictive. OxyContin’s maker, Purdue Pharma, later agreed to plead guilty for misleading the public about the drug’s risks.
The CDC delayed its guidelines earlier this year following criticism from pain specialists, drugmakers and others. Critics complained that the recommendations went too far and had mostly been developed behind closed doors by physicians who are biased against drug therapy. Instead of releasing the guidelines in January, as originally planned, the CDC agreed to re-open them to public input, receiving more than 4,000 comments over a 30-day period.
Last week, lawmakers in the Senate overwhelmingly passed a bill designed to combat opioid abuse, including a provision requiring the Veterans Administration to adopt the CDC recommendations. The bill still needs to go to the House for approval