No More Narcotics For Treating Chronic Pain, Says The CDC

The Centers for Disease Control (CDC)  is urging physicians to avoid prescribing opiate painkillers for patients with chronic pain. 

The CDC announced this action Tuesday to help fight the nation's prescription painkiller problem.  

While this doesn't include patients receiving cancer or end of life treatment it does provide a guideline for physicians who prescribe narcotics for patients with chronic pain. It's the first time the CDC has ever provided recommended guidelines for doctors who prescribe narcotics. 

The guidelines suggest that when narcotics are necessary they are prescibed in the lowest dose for the shortest duration. 

"We know of no other medication routinely used for a nonfatal condition that kills patients so frequently," said CDC director Thomas Frieden. "We hope to see fewer deaths from opiates. That's the bottom line. These are really dangerous medications that carry the risk of addiction and death."

The guidelines are directed at Primary care physicians who prescribe nearly half of the opiate pain medications. It is not mandatory for physicians to follow the guidelines, but often doctors are influenced by CDC suggestions. 

When a doctor prescribes any medication the risks vs the benefits must be closely examined. But in the case of narcotics, the risks can sometimes outweigh the benefits.  The CDC hope to help physicians decided when to prescribe these powerful drugs and when to try other treatments, such as steroid injections, physical therapy, and other treatment modalities. 

The executive director of Physicians for Responsible Opioid Prescribing said the guidelines were a "game changer" because doctors are usually receptive to CDC recommendations. 

"For the first time, the federal government is communicating clearly that the widespread practice of treating common pain conditions with long-term opioids is inappropriate," Kolodny said. "The CDC is making it perfectly clear that medical practice needs to change because we’re harming pain patients and fueling a public health crisis."

Chris Hansen, the president of  the American Cancer Society Cancer Action Network  has criticized the CDC for disregarding the important role of pain management for cancer survivors "who experience severe pain that limits their quality of life."

"Pain does not end when an individual completes treatment," he said in a statement. "Most often, cancer patients deal with lasting effects from their disease or treatment including pain for a significant period of time or indefinitely."

Frieden says that many prescription narcotics are as addictive as heroin and don't adequately control chronic pain.  Aspirin, Ibuprofen, and other non-addictive choices should be used first. 

When the benefits of taking narcotics outweigh the risks, doctors should discuss treatment goals with their patients.  Plan how long the therapy will be and avoid prescribing while patients are taking other addictive drugs, like benzodiazepines. 

Patients who have acute pain from injuries usually need narcotic pain relief for three days. According to Frieden, it is not necessary to prescribe these drugs for any long than seven days. 

"When opiates are used, start low and go slow," Frieden said. Evaluate each patient every three months to see whether the benefits still outweigh the risks. 

Counseling patients about the dangers of these medications  "will help prevent patients from getting addicted and help keep highly addictive drugs from accumulating in medicine chests," Kolodny said.

For years, physicians have been taught that pain is a vital sign, so the CDC's decision to address this could cause some push-back with physicians who want to help their patients and may feel as if they're turning a blind-eye to their patient's chronic pain by not treating with narcotics. 

There is also the problem of physicians who have treated some patient's chronic pain for many years. How will they tell these patients that they can no longer have the medication they have become dependent of for pain relief? 

The Drug Enforcement Agency (DEA) has placed restrictions on physicians and forced them to comply with excessive paperwork and red-tape to prescribe narcotic medications to their patients. The result is that many doctors are now unwilling to prescribe these drugs because of  time restraints, the hassle of extra paperwork and liability. 

There is also the issue of the DEA and the CDC being government agencies. Some people feel the government and their opinions have no place in healthcare and perhaps we should allow physicians to do what they're qualified to do without the interference of the government. 

As a healthcare professional I have mixed feelings about this. How do you feel about this article? Comment below!