CDC released new guidelines for prescribing opioids drugs used for relieving chronic pain, at the end of March 2016 in United States, which were reviewed online in the Tuesday’s issue of The Journal of American Association (JAMA). The new guidelines were recommended for prescribing opioids to primary care clinicians treating adult patients with chronic pain outside of ‘active cancer treatment’, ‘palliative care’, and ‘end-of-life care’.
The measure was taken by CDC after conducting a review on the pros and cons of opioids supplementation. Different factors regarding efficacy, risk assessment and cost effectiveness were also evaluated during a systematic review carried out by using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework, in 2014. The procedure used for evaluation was not a meta-analysis because of the inconsistency and limitations in the different study designs chosen for the analysis.
The findings of the analysis indicated increased risks of developing disorders, even leading to death due to overdose resulting from usage of opioid drugs. The results of the analysis also concluded no significant long term benefit i.e., more than a year, pertaining to opioids consumption used for relieving chronic pain in patients.
Dr Debra Houry, who is the Director at CDC’s National Center for Injury Prevention and Control, while describing the new set of guidelines issued by CDC, stated her viewpoint on Huffington Post by saying that the guidelines are developed by keeping most recent evidence ‘known about opioids’ under consideration. She added that the guidelines comprise of twelve recommendations directed for the medical practitioners for prescribing opioid medicines to treat the adult patients who experience severe pain for a period of longer than normal tissue healing i.e., three months. Moreover, she made it clear that there are no recommendations for the patients in ‘active cancer treatment’, ‘palliative’ or ‘end-of-life care’.
However, she believes that this move will serve as a helpful tool for the doctors, as the guidelines include recommendations about clinical decision making, as well as good pointers for encouraging better communication between the doctors and the patients. Another very important aspect covered by CDC is the specification of the dosage for the patients suffering from acute pain and caution for not prescribing more amount of immediate-release opioids than required.
Dr Debra while commenting on the unnecessary use of opioid drugs stated that opioids drugs are mostly prescribed to patients after a surgery or major injury and the use of these drugs have increased over the past few years, especially for the treatment of severe pain in the back experienced by the patients of osteoarthritis. Furthermore, she said that the evidence about the effective treatment is lacking. Therefore, the concerns about the serious risks of addiction and overdose related to these drugs are increasing.
She added, “There are also other treatments, such as exercise therapy and non-steroidal anti-inflammatory medications that can be more effective, with less serious risks.”
CDC Director Tom Frieden, MD, MPH, while supporting the move of recommending new guidelines, said, “More than 40 Americans die each day from prescription opioid overdoses. We must act now,” he said and added, “Overprescribing opioids—largely for chronic pain—is a key driver of America’s drug overdose epidemic. The guideline will give physicians and patients the information they need to make more informed decisions about treatment.”
According to CDC, since 1999, opioid prescriptions have multiplied exponentially and more than 165,000 people have died from the use of prescription opioids till date.
Charles Argoff, MD, Director, Comprehensive Pain Program at the Albany Medical Center in New York, said in an interview that the new guidelines have hope for tackling the excessive use of opioids. According to him, the recommendations provided by CDC have a huge potential of guiding doctors who do not deal with cases of pain management and would draw a clear line between the patients who should and should not be prescribed the opioids medications. He brought it up to the attention that many doctors follow an inappropriate prescribing behavior and give opioid drugs to the teen-aged patients who normally would not need it, after a tooth extraction.
“So, I am not naive that we are facing a national crisis of significant opioid-related adverse outcomes, and we are facing a national crisis with chronic pain. I would only hope that this is the spirit of this guideline—to enhance safe, effective therapy—and not to block access to medications to those who need them,” Dr Argoff added.
Opioid drugs have also been reported for interrupting other normal physiological processes of the body including raised serotonin levels in brains due to interaction with antidepressants in the body. Long term use of opioids was seen to affect major hormones of the body such as cortisol and leave patient on the verge of impotency and infertility.
Many measures were taken by the US government to outplay opioid addiction with the help of money and effective policies, including President Barack Obama’s allocation of $1.1bn for the treatment of opioid addiction in the US.