Opioids are Inappropriate Medicine for Chronic Pain
The Centers for Disease Control and Prevention (CDC) released on March 15, 2016, its eagerly awaited report on opioids and the corresponding guidelines for their use as medicine for chronic pain. Presented in a Journal of American Medicine (JAMA) article, the CDC report on opioids and their use clearly states that opioids have been misused and overprescribed by doctors, and that non-opioid medicine is usually a more appropriate choice. As the report states “Evidence of long-term efficacy of opioids for chronic pain is limited. Opioid use is associated with serious risks, including opioid use disorder and overdose.” The CDC guidelines are not formally binding, but as the New York Times responded to the report in an editorial titled “A Strong Response to the Opioid Scourge”, the findings are an important and powerful step in the right direction. As further evidence of the critical nature of this development, in a recent New England Journal of Medicine article on the report CDC Director Thomas R. Frieden, M.D., M.P.H. and Debra Houry, M.D., M.P.H., write about the findings and their importance. The new guidelines are an important part of a federal response to the increasing rate of opiate addiction in the U.S. In 2013 alone approximately 250 million painkiller prescriptions were written. This is enough, according to the CDC, “for every American adult to have a bottle of pills.” More than 165,000 people in the U.S. have died since 1999 of causes related to usage of painkillers. The CDC guidelines note that the increase in deaths have paralleled a huge increase in the sales of opioid drugs. The CDC recommends doctors choose treatments other than opioid painkillers. These include less powerful and less addictive medications such as acetaminophen and ibuprofen. Other recommendations for alternatives treatments include exercise regimens and behavioral therapy. The report states that if opioid painkillers are prescribed, doctors should use the lowest dose possible and monitor patients closely for signs of abuse. In addition, the report suggests that three days of opioid painkillers should normally be sufficient for short-term acute pain, such as recovery from surgery or from trauma. This recommendation can help with the problem of leftover pills in medicine cabinets, which have long been a source of abuse for teenagers and others as well. The CDC report on opioids and their use apply to chronic pain patients – defined as those whose pain persists longer than three months – but not cancer patients or the terminally ill. The CDC said it conducted an exhaustive review of scientific literature and consulted with hundreds of leading experts, government agencies, advocacy groups, and citizens, as part of its process in drawing up the guidelines. According to the agency, those scientists who had “significant” ties to the pharmaceutical industry were not involved in the process of creating the report and the guidelines.