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New Guides for Opiod Pain Med Scrips

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New Guidelines for Opioid Pain Med Scrips

-Dave McNamara

Opioid pain medication abuse has become a growing problem. The number of opioid deaths in America has reached a record of 28,647 in 2014, according to the most recent federal statistics. In light of this, The New York Times recently reported that the Center of Disease Control and Prevention (C.D.C.) has recently released a revised, more restrictive, set of guidelines to prescribe them. The new guidelines have sparked some debate, especially between those who suffer from chronic pain, and those whose loved ones have been lost by opioid prescription abuse.

Two Sides
Pain management doctors and drug industry groups have opposed the new measures, which they believe would make it harder for those with legitimate long-term pain to receive the medication they need. Those in favor of the strictures see them as much-needed policy changes to those made two decades ago. Back then, opioids such as OxyContin, Percocet, and Vicodin became the most widely prescribed drugs in the country, with sales reaching the $2 billion a year mark, according to IMS Health, a research firm that collects prescribing data.

Implications
The recommendations made by the C.D.C., it should be noted, are federally nonbinding and are meant as guidelines. Yet guidelines carry with them significant weight. Some mention doctors fearing lawsuits would follow them as if they were legally binding. There is also a growing concern insurance companies could begin to use them to determine reimbursement.

Overview of the Guidelines

  • The guidelines are intended for primary care doctors, who prescribe about half of all opioids, with little training in their implementation.
  • They call for patients to be urine tested before receiving a prescription, and for doctors to check prescription-tracking systems to ensure patients are not getting the medicine somewhere else, or under false pretenses.
  • They also do not apply to prescriptions for patients receiving cancer or end-of-life treatment, or to patients who have had surgery.
  • These guidelines could also affect dental practices. In a study of more than two million patients undergoing surgical tooth extractions covered by Medicaid, researchers at Harvard University found evidence that nearly half the patients were prescribed an opioid, including 61 percent of teenagers.

One Side’s Reactions

  • Dr. Thomas R. Frieden, director of the C.D.C., stated in a phone interview to reporters, “It has become increasingly clear that opioids carry substantial risk but only uncertain benefits — especially compared with other treatments for chronic pain,” Dr. Frieden went on to explain the document was meant to be “a tool for doctors and for patients to chart a safer course.” In other words, the mandates are not to be set in stone, but rather a document helping doctors know in which instances to prescribe pain medication.
  • Many in politics, law, and the medical community were at odds about the best way to address what the Times calls the “Opioid Crisis.” However, with death tolls rising in alarming rates recently due to the drug, seem to have brought an urgency to the problem, while allowing all parties to work more corporately towards a solution.
  • “This is the first time the federal government is communicating clearly to the medical community that long-term use for common conditions is inappropriate,” stated Dr. Andrew Kolodny, head of group Physicians for Responsible Opioid Prescribing. “It’s one of the most significant interventions by the federal government.”

The Other Side’s Reactions

  • “These will not be seen as voluntary,” said Myra Christopher. Christopher is the director of a coalition of medical and patient advocacy groups focused on chronic pain care called the Pain Action Alliance to Implement a National Strategy that oppose the guidelines. “These will become the definition of the standard of care, because of the clout of the Centers for Disease Control.”
  • Other groups opposing the drug’s restriction received the recent developmental guidelines in a reserved manner, however. Robert Twillman, the executive director of the American Academy of Pain Management, stated, “the numbers are still arbitrary.” He was referring to the recommended limits for daily dosage and days of treatment, but also commented, “on the whole, it’s not bad.”
  • The Washington Legal Foundation, a conservative group that represents pharmaceutical companies in legal cases, has threatened to sue the C.D.C., saying the agency failed to follow federal rules in developing the proposal.

Conclusion

The scope and implications of these new guidelines will be made more clear in the future. But for now, the balance between giving relief of pain to those who need it, and restricting it from those susceptible to abusing it, is a tenuous one.

References

  1. Sabrina Tavernise, ‘C.D.C. Painkiller Guidelines Aim to Reduce Addiction Risk’, Health (The New York Times), March 16, 2016, http://www.nytimes.com/2016/03/16/health/cdc-opioid-guidelines.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=first-column-region®ion=top-news&WT.nav=top-news&_r=0#story-continues-7.
  2. G, DONALD, SABRINA TAVERNISE, THE EDITORIAL BOARD, ELI ROSENBERG, AMY CHOZICK, MICHAEL WINES, JONAH BROMWICH, et al. ‘Centers for Disease Control and Prevention’.Centers for Disease Control and Prevention, March 8, 2016. http://www.nytimes.com/topic/organization/centers-for-disease-control-and-prevention?inline=nyt-org.
  3. Baker, James A, Division of Pharmacoepidemiology, Brigham Pharmacoeconomics, Women’s Hospital, Boston, Jerry Avorn, Raisa Levin, and Brian T Bateman. ‘Surgical Tooth Extraction and Prescribed Opioids in Medicaid Patients’. March 15, 2016. Accessed March 20, 2016. http://jama.jamanetwork.com/article.aspx?articleid=2503505.
  4. CDC. ‘Increases in Drug and Opioid Overdose Deaths — United States, 2000–2014’. January 1, 2016. Accessed March 16, 2016. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6450a3.htm.
  5. Dowell, Deborah, Tamara M Haegerich, and Roger Chou. ‘CDC Guideline for Prescribing Opioids for Chronic Pain, 2016’. March 15, 2016. Accessed March 16, 2016. http://jama.jamanetwork.com/article.aspx?articleid=2503508.
  6. Frieden, Thomas R. and Debra Houry. ‘Reducing the Risks of Relief — the CDC Opioid-Prescribing Guideline’. New England Journal of Medicine March 15, 2016,. doi:10.1056/nejmp1515917.
  7. ‘Surgical Tooth Extraction and Prescribed Opioids in Medicaid Patients’, JAMA, March 15, 2016, accessed March 20, 2016, http://jama.jamanetwork.com/article.aspx?articleid=2503505.
  8. Project, PAINS. ‘BREAKING NEWS – CDC Guideline for Prescribing Opioids for Chronic Pain – PAINS – Pain Action Alliance to Implement a National Strategy’. March 15, 2016. Accessed March 16, 2016. http://www.painsproject.org/breaking-news-cdc-guideline-for-prescribing-opioids-for-chronic-pain/.