Public health officials are in agreement: the United States has an opiate problem. There has been a steady increase in the scope of the opiate problem in this country, with unintentional overdose deaths more than quadrupling since 1999. In 2012, the latest year for which figures are available, approximately 2.1 million Americans suffered from prescription opiate abuse. Another 467,000 are addicted to heroin. Finding solutions to this problem is a public health priority. However, recent prescribing guidelines drafted by the Centers for Disease Control and Prevention (CDC) have recently come under fire.
The Scope of the Opioid Prescribing Problem
In 2012, more than 250 million prescriptions were written for opioid painkillers. That is enough for each American adult to have his or her own bottle of pills. Although many of these prescriptions were to help individuals coping with serious illnesses or chronic pain problems, other prescriptions may not be medically warranted.
Americans are not reporting higher levels of pain than in 1999, yet prescriptions of opioid painkillers are up 300%. This suggests that physicians may be prescribing opioid pain pills more often than is necessary or medically appropriate. Unfortunately, this high level of prescribing leads to increased use and abuse of prescription opioids. These drugs have a high addictive potential, meaning that many people who begin taking them for legitimate medical issues soon find themselves unable to control their use. This has serious long-term consequences, as prescription opiates can be dangerous when taken at high doses or for long periods of time.
Draft CDC Guidelines for Opioid Prescribing
In response to the U.S. opioid crisis, the CDC drafted guidelines for medical professionals who prescribe opiates. The major intended audience is primary care physicians. The guidelines include recommendations about when to initiate opioid medications for chronic pain; how to select, dose, and discontinue opioids; and assessment of the risks and benefits of opioid use.
The draft CDC guidelines are based on scientific consensus from leading experts, including representatives from the American Academy of Family Physicians, the Society of General Internal Medicine, and the American College of Physicians. The recommendations are intended only for health care professionals who prescribe painkillers in a primary care setting for chronic pain lasting more than 3 months. Thus, they are intended to stem the reliance on prescription opioids as a first-line defense against chronic pain.
The CDC guidelines include a recommendation that non-pharmacologic treatment be preferred over opioids when possible. Additionally, providers should have conversations with patients about their expectations and prognosis for pain management with opioids versus other methods of pain relief. Furthermore, prescribers should use immediate-release opioids rather than extended release formulations. They are also advised to use a lower starting dose and limit the amount of opioids provided for acute pain.
Controversy and Future of the Guidelines
Unfortunately, the CDC guidelines have been met with significant controversy. Some doctors believe that the controversy is fueled by political and economic motivations from those who are influenced by pharmaceutical companies. The CDC has taken the unprecedented step of opening the draft guidelines to public comments; this is unheard of for scientific recommendations made by an expert panel.
Of course, many patients are afraid that the new guidelines may limit their ability to get prescription opioids that they need to function well. This is an understandable concern, and all health care professionals should be working with such patients to help them achieve good pain management. This may involve exploring alternatives to opioid medications, which can be damaging when taken for longer periods of time.
The status of the draft CDC guidelines is still in flux. A new expert panel has been created to further evaluate the recommendations and make changes as needed. At the Waismann Method Center, we believe that these draft CDC guidelines represent an important step in the right direction. Getting prescribing practices under control is just one piece of the puzzle. Increasing access to effective treatment programs such as medical opiate detox is also essential to helping opiate users get the help they deserve.
America’s Addiction to Opioids: Heroin and Prescription Drug Abuse, NIH, Retrieved on January 18, 2016.