In the face of a growing opioid epidemic in the United States, the Centers for Disease Control and Prevention have released new guidelines for prescribing opioids. The opioid abuse problem is multifaceted and complex. One piece of the problem is physicians overprescribing potent opioid painkillers for a range of conditions. The new CDC guidelines are intended to clarify the appropriate procedures for the prescription of opioids to make recommendations that will curb the incidences of opiate overdose in the United States.
The Scope of the Opioid Abuse Problem
The opioid epidemic continues to accelerate rapidly. Nearly half a million people in the United States are addicted to heroin, according to the figures from the National Institute on Drug Abuse. Furthermore, since 1999, rates of fatal overdose from prescription opioids have more than quadrupled. An estimated 2.1 million Americans are now addicted to prescription painkillers.
The reasons for this increase in prescription opioid abuse are multifactorial. Availability of illicit heroin and opioids have increased. People use these substances to self-medicate for underlying emotional or psychological problems. Furthermore, some newer opioids are even more powerful than their predecessors, increasing the likelihood of a person developing physical dependence on the drugs.
On top of these other problems, there has been a sharp spike in the number of prescriptions written for opioid painkillers. In 1991, physicians wrote approximately 76 million such prescriptions. That number jumped to approximately 207 million prescriptions in 2013, according to the National Institute on Drug Abuse. This makes the United States the greatest global consumer of opioids, including close to 100% of the hydrocodone (e.g., Zohydro, Vicodin) sold in the world.
New CDC Guidelines for Prescribing Opioids
Recognizing that the uptick in opioid painkiller prescriptions is contributing to the nation’s opioid epidemic, the Centers for Disease Control and Prevention established a group of pain management experts to draft guidelines to aid physicians as they make decisions about opioid painkiller prescriptions. It is important to note that these guidelines are not binding; physicians are still free to make any decision they want about whether to prescribe an individual patient opioids. However, the guidelines provide a framework to guide physicians in their decision-making and represent best practices in the field of medicine.
In reviewing evidence supporting the use of opioids, the CDC found that there was limited scientific evidence suggesting that long-term opioid treatment for chronic pain was effective outside of cancer or end-of-life care settings. With the potential for adverse events, including physical dependence or overdose, the widespread use of these medications is troubling. Thus, the new CDC guidelines include the following:
- Whenever possible, physicians should provide recommendations for nonpharmacological therapy or non-opioid pharmacological therapy. For example, cognitive behavioral therapy, physical therapy, and certain forms of exercise can alleviate pain. Furthermore, other drug classes, such as NSAIDs, acetaminophen, and certain antidepressants, can be effective in treating chronic pain.
- Physicians should establish treatment goals with patients before prescription opioid painkillers. This should include a discussion of goals for pain and everyday functioning.
- Physicians should discuss benefits and risks of opioid therapy as well as how both the physician and patient will manage medications.
- Doctors should begin by prescribing immediate-release rather than extended-release opioids, which have a higher abuse potential.
- Physicians should begin by prescribing the lowest effective dosage of opioids. They should consider risks of prescribing opioids stronger than 50 morphine milligram equivalents per day and should avoid increasing dosages to 90 morphine milligram equivalents per day whenever possible.
- For patients with acute pain, prescription opioids should not be given for greater than three days. More than seven days of opioid therapy are rarely needed for acute pain situations.
- Within one to four weeks of beginning opioid therapy, physicians should evaluate possible risks and harms to the patient to determine if continuation of therapy is appropriate.
If properly implemented by physicians, these guidelines may significantly reduce physician prescriptions of opioid painkillers in the United States. However, some patients will continue to struggle with opioid dependence. Increasing access to effective treatments that help patients through the withdrawal process, such as medical detox programs, is essential to combating the addiction problem at its source.