In an effort to stem a rising tide of opiate addiction and overdose deaths, the Centers for Disease Control and Prevention (CDC) has announced new opioid usage guidelines for physicians treating patients with chronic pain conditions. 2014 saw a record-breaking number of opioid overdose deaths, and 1 in 4 people with a chronic pain condition suffer from opioid addiction.
In an interview with USA Today, CDC director Thomas Frieden said
“We know of no other medication routinely used for a non-fatal condition that kills patients so frequently. We hope to see fewer deaths from opiates. That’s the bottom line.”
Opioid medications like Vicodin and OxyContin are so commonly prescribed for pain relief following dental surgery and minor car accidents that it’s easy to forget how addictive they are. They fall into the same family of drugs as stronger medications like morphine and illicit substances like heroin. The CDC’s recommendations strongly discourage doctors from prescribing them for chronic pain and urge caution when prescribing for acute pain.
Many people that become addicted start out simply seeking pain relief after an injury or trying to cope with chronic pain. Misleading marketing campaigns in the 1990s lead many people to believe opioids were a safe avenue for pain relief, and doctors were put under significant pressure to alleviate their patient’s pain utterly and immediately instead of setting realistic, safe treatment goals.
The new guidelines focus on three key areas, including patient safety, regular evaluation of patient well-being and scrupulous, limited prescription of opioids as a last resort. They begin by emphasizing that non-pharmaceutical, non-opioid therapies should be the first-line treatment for chronic pain conditions. This means options like therapeutic massage, NSAIDs. and even cognitive behavioral therapy are worth exploring before or using alongside opioids for pain relief.
When opioids are an appropriate choice for pain relief, the CDC has a number of recommendations for curbing the risk of addiction. They urge doctors and patients to discuss the risks and develop realistic pain relief goals before treatment begins. They recommend going “low and slow” with regular evaluation and acting quickly if addiction is suspected.
The announcement isn’t without controversy. One of the hotly contested points is the three-day rule, suggesting doctors limit the use of opioids when treating acute pain to three days in low-risk situations. Another recommendation ruffling feathers suggests doctors perform urine screenings to ensure patients on long-term opioid treatment plans aren’t abusing their prescription or other substances.
Critics of the recommendations, including the American Academy of Family Physicians, argue that there isn’t enough proof the guidelines will stem the tide of addiction or offer enough benefit to the patients for how stringent they are. Speaking with NPR, Dr. Debra Houry, the director of the CDC’s National Center for Injury Prevention and Control, countered that there isn’t sufficient evidence that opiates offer adequate pain relief to chronic pain sufferers in the first place.
More importantly, she notes, “There is room for more science as we continue to revise and update the guidelines, but given the number of Americans dying each day from opioid overdoses — 40 a day — we have enough evidence today about the risks.”
The CDC states the guidelines are not meant to apply to cancer treatment or end-of-life care. The full set of guidelines was published in the JAMA and is available to the public.
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