The Centers for Disease Control (CDC) released new CDC guidelines (cdc.gov/mmwr) recently to limit the prescribing of prescription painkillers, such as OxyContin and Vicodin. The CDC guidelines are voluntary and urge primary care doctors to try physical therapy, exercise, and over-the-counter medications before prescribing painkillers for chronic pain. The CDC issued the guidelines in response to a growing epidemic of addiction and abuse of opioid painkillers in the United States. In the last 20 years, there has been a four- fold increase in the number of overdose deaths tied to use of opioid painkillers. More than 40 Americans die each day from painkiller overdoses, according to the CDC.

The guidelines also recommend limiting use of opioid painkillers for patients suffering short term acute pain, to no more than three days of treatment.  The CDC recommends using the lowest effective dose possible when prescribing painkillers. These CDC guidelines do not apply to specialists who treat severe pain due to cancer or other debilitating illnesses, palliative or end-of-life care.

“If you are prescribing an opiate to a patient for the first time, that’s a momentous decision,” said CDC Director Tom Frieden in a recent interview. “That may change that patient’s life for the worse forever.  So you’ve really got to think carefully before doing it.”
“We are trying to chart a safer and more effective course for dealing with chronic pain.  The risks of addiction and death are very well documented for these medications,” Dr. Frieden added.

The CDC does not usually make recommendations to physicians on how to prescribe medications.  This role is generally left to professional organizations and drug regulators. The American Medical Association (AMA) stopped short of endorsing the new guidelines, and raised concerns about accessibility to effective pain treatments for patients, and denial of coverage by insurance companies. The American Academy of Pain Management responded to the guidelines by stating that these guidelines could not be effectively applied “when the pain comes from trauma or a surgery that could last weeks sometimes.”

Government officials and various state governments have tried to tackle the epidemic of painkiller addiction and abuse in their states. The Food and Drug Administration issued rules to limit refills for prescribed painkillers.  The FDA  just released new guidelines for labeling opioid painkillers to require the strongest warning labels. The state of Florida and New York passed laws to create databases to monitor doctors who prescribe opioid painkillers in an effort to crackdown on “pill mills.” Massachusetts recently passed a law to limit first-time prescription of opioids to seven days.

Source: CDC Guideline for Prescribing Opioids for Chronic Pain – United States, 2016 (http://www.cdc.gov/mmwr)

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