I recently wrote about the opioid epidemic that lead to a serious increase in the numbers of people addicted to narcotic pain medicines and increased deaths from overdose. In response to this tragic problem, in March 2016, the US Centers for Disease Control and Prevention (CDC) issued guidelines for prescribing opioids for chronic pain. The guidelines recommended that primary care physicians:
- Consider non opioid medicines first, and only prescribe opioid medicines in conjunction with other therapies, i.e. physical therapy, exercise, or weight loss.
- Before starting opioid therapy, establish clear goals for function and timing of use. If the goals are not met, and the patient's quality of life is not significantly improved, then discontinue the use of opioids.
- Thoroughly discuss the risks and benefits, including addiction and death, with patients and ensure the patient understands their responsibility in managing the medication.
- Initially, only prescribe the lowest dose of immediate release medications, instead of long acting opioids.
- Avoid increasing dosing to over 50 mg per day.
- When opioids are prescribed for acute pain, the dose and number should be strictly limited. Three days or less should be the norm.
- Prescription of opioids should be reevaluated frequently, with the eye toward discontinuation if the patient's quality of life has not significantly improved.
- Ensure the patient's medicines are coming from only one place, and ensure that databases are used to track opioids. Use drug testing to ensure compliance.
- Opioids should not be prescribed with benzodiazepines (anti-anxiety medicines).
- Patients that are shown to be addicted and exhibiting drug seeking behavior should be referred for appropriate treatment and therapies.
Despite that these recommendations seem rather common sense, they were met with significant opposition. The American Medical Association, American Academy of Pain Medicine, and American Academy of Pain Management all were critical of the attempt to significantly limit the use of long term opioid pain medicines.
A recent report in the well-respected Journal of the American Medical Association, documented that some of this opposite was likely influenced by drug manufacturers. The report discussed that the authors of the numerous comments made by various organizations failed to disclose they received funding from opioid drug manufacturers. Moreover, opposition to the guidelines were far more frequent by organizations that received funding from opioid manufacturers. This lack of transparency and relationship between criticism and funding places further question on drug manufacturer's commitment to addressing this national tragedy.
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