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CDC issues restrictive new guidelines for opioid painkillers

The agency said acute pain patients often require less than a week of opioid drugs, and chronic pain patients would be better helped with other forms of treatment.
By Stephen Feller   |   March 16, 2016 at 10:34 AM

ATLANTA, March 16 (UPI) -- The federal government issued new guidelines this week recommending doctors prescribe opioid painkillers for a week at most, and suggesting chronic pain not be treated at all with the drugs.

The Center for Disease Control and Prevention is changing recommendations in an effort to curb growing rates of addiction to opioid drugs such as OxyContin and Vicodin as doctors have prescribed them more often and in greater quantities than may be best for patients.

The drugs, marketed to doctors and hospitals as having low risk for addiction, have been used increasingly in the last two decades for all manner of pain. For many patients with chronic pain, or who have been prescribed the drugs for too long because of temporary conditions, addiction has become a significant problem.

In 2012, 259 million prescriptions were written for opioids, increasing 7.3 percent from 2007 to 2012, according to the CDC. From 1999 to 2014, 165,000 people died from overdoses of prescription painkillers, an increase the agency reports has mirrored the huge increase in use of the drugs during that time.

Recent studies have found doctors are aware the drugs are overprescribed, but say they have to balance patients' chronic pain conditions with their potential to develop a dependence on them. In many cases, patients who have overdosed continue to receive prescriptions for opioid drugs, exacerbating the problem.

With a well-known litany of evidence showing the addiction problem, other research is showing far less of the drugs are needed for many patients, if the drugs are even necessary -- a study in Canada showed physical therapy patients fared better without opioid painkillers.

"It's the first time the federal government has clearly communicated to the medical community that widespread and routine practice of treating long-term chronic pain with opioids is inappropriate," Dr. Andrew Kolodny, executive director of Physicians for Responsible Opioid Prescribing, told STAT.

The new guidelines, published as part of the agency's Morbidity and Mortality Weekly Report, lay out a set of recommendations meant to help doctors minimize, if not outright avoid, the use of opioid drugs for patients who do not have cancer, or require palliative or end-of-life care.

Researchers at the agency reviewed clinical trials, data on prescriptions, use, and abuse of the drugs, finding most trials with the drugs lasted six weeks or less, but that patients are often on them for much longer periods of time. The data shows the longer the drugs are used, the less effective they are against pain or in helping patients recover, and long-term use significantly increases the risk for addiction.

The agency says doctors should first look to use non-pharmacologic, or at least nonopioid, treatment for chronic pain. In cases where these are not effective, or effective enough, careful consideration of risks should be considered, with specific goals for their use set out before starting.

When prescribed, the CDC says doctors should use the lowest effective dose of immediate release opioids, rather than extended-release or long-acting ones.

"Management of chronic pain is an art and a science," Dr. Tom Frieden, director of the CDC, and Dr. Debra Houry, director of the National Center for Injury and Prevention Control, write in an editorial on the new guidelines published in the New England Journal of Medicine. "The science of opioids for chronic pain is clear: for the vast majority of patients, the known, serious, and too-often-fatal risks far outweigh the unproven and transient benefits."

The expectation, Frieden writes, is for stronger painkillers such as opioids to be used for three to seven days at the most for acute pain, but that longer term pain management techniques should be adopted to help patients avoid addiction.

Some doctors and experts are concerned the guidelines will endanger effective treatment for patients who actually benefit from opioids, but the CDC said doctors should curtail use while basing decisions on individual conditions.

"The urgency of the epidemic, its devastating consequences, demands interventions that, in some instances, may make it harder for some patients to get their medication," Dr. Nora Volkow, director of the National Institute of Drug Abuse, told the New York Times. "We need to set up a system to make sure they are covered. But we cannot continue the prescription practice of opioids the way we have been. We just can't."

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