The Centers for Disease Control and Prevention (CDC) urge doctors to stop treating chronic pain with opioid medications, such as oxycodone, morphine, and hydrocodone. The CDC published guidelines on opioid prescribing in March of 2015 in the Journal of the American Medical Association. Typically used to treat pain related to terminal illness or surgery, opioids are powerful, addictive painkillers. Long-term use of these medications are associated with a risk for dependence, addiction, overdose, and even death.
The United States is experiencing an epidemic of prescription opioid misuse and overdoses. Increased sales and prescribing of opioids has quadrupled since 1999, which has created and fueled a opioid epidemic. The CDC urges doctors to prescribe the lowest doses when narcotic analgesics are necessary, and to reassess the benefits and risks every three months.
The new guidelines provide recommendations on the use of opioids for treating chronic pain, which is pain that persists for longer than three months or past the time of normal healing. Chronic pain is viewed as a public health issue in the U.S., and these new guidelines are designed for primary care providers, who prescribe almost half of all opioid medications.
Statistics Related to Opioid Pain Medications
The number of individuals with chronic pain is estimated at 11% of the adult U.S. population. Around 4% of these patients are prescribed long-term opioid medications. Evidence shows that short-term efficacy of opioids in randomized clinical studies lasting 12 weeks or less, and patients on these medicines report some pain relief when surveyed. However, from 1999 to 2014, more than 165,000 people died from overdose-related deaths, which were associated with opioid pain medications. In 2013, almost 2 million people abused or became dependent on prescription pain medications.
Prescription opioid abuse takes a toll on patients, physicians, and society. Nonmedical use of prescription opioid pain relievers is one of the most disturbing public health issues, with abuse of these agents quadrupling from 1990 to 2014. In addition, the overall cost of prescription drug abuse in the U.S. is estimated to be around $9.5 billion, including healthcare costs, criminal justice costs, and workplace costs.
Medications Recommended by New CDC Guidelines
The CDC is recommending that physicians treat chronic pain with non-opioid painkillers and alternative agents. These include:
- Acetaminophen (Tylenol)
- Nonsteroidal anti-inflammatory drugs (NSAIDS) (ibuprofen, ketoprofen, and naproxen)
- Anticonvulsants (Pregabalin and Gabapentin)
- Tricyclic antidepressants (amitriptyline and nortriptyline)
- Serotonin norepinephrine reuptake inhibitors (SNRIs)
Prescription opioids have serious risks, and the new guidelines are aimed to improve the safety of medication prescribing. These recommendations focus on increasing the use of alternative treatment measures for chronic pain, such as procedures, interventions, and physical therapy.
Three Principles to Improve Patient Care
Among the 12 recommendations, there are three key principles for the improvement of patient care. These are:
- Nonopioid therapy is preferred for chronic pain other than palliative, active cancer and end-of-life care.
- Providers should exercise caution when prescribing opioids and monitor patients closely.
- When opioids must be used, the lowest dose possible should be prescribed to reduce the risk of overdose and addiction.
The CDC followed a rigorous scientific process in developing these guidelines. This involved the best available scientific evidence, listening to comments and concerns from the public and family members, and consulting with experts. The CDC is dedicated to improving the evidence base, and plans to refine these recommendations as better evidence is available.
Passik SD (2009). Issues in Long-term Opioid Therapy: Unmet Needs, Risks, and Solutions. Mayo Clinic Proc, 84(7), 593-601.