By:  Kumar W. Giri

May 21, 2016

“44 people die in the United States from an overdose of prescription painkillers, according to the Centers for Disease Control and Prevention. Drug overdose is now the the leading cause of accidental death in the United States, surpassing car crashes, according to the American Society of Addiction Medicine.” (USA TODAY 2016)

Stats like the ones above have pushed the CDC to start investigations into the root cause of the opiate epidemic.  Several months ago they issued new guidelines for the prescription of opiates for acute and chronic pain relief.  The study which was published in JAMA, concluded with 12 recommendations for physicians, nurses and other clinical staff.  

The recommendation that stand out the most is:

“Long-term opioid use often begins with treatment of acute pain. When opioids are used for acute pain, clinicians should prescribe the lowest effective dose of immediate-release opioids and should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. Three days or less will often be sufficient; more than 7 days will rarely be needed” (JAMA, 2016)

There has been a lot of talk recently about doctors and other medical professionals over prescribing opiates for years.  This study supports the idea that doctors need to pull back the amount of opiates that are being prescribed to patients for acute pain, at most the patients that suffer acute symptoms should get a maximum seven day supply and at most times not more than three.

Other recommendations include:

When prescribing opioids for chronic pain, clinicians should use urine drug testing before starting opioid therapy and consider urine drug testing at least annually to assess for prescribed medications as well as other controlled prescription drugs and illicit drugs.

Clinicians should avoid prescribing opioid pain medication and benzodiazepines concurrently whenever possible.

When opioids are started, clinicians should prescribe the lowest effective dosage. Clinicians should use caution when prescribing opioids at any dosage, should carefully reassess evidence of individual benefits and risks when considering increasing dosage to 50 morphine milligram equivalents (MME) or more per day, and should avoid increasing dosage to 90 MME or more per day or carefully justify a decision to titrate dosage to 90 MME or more per day

When prescribing opioids for chronic pain, clinicians should use urine drug testing before starting opioid therapy and consider urine drug testing at least annually to assess for prescribed medications as well as other controlled prescription drugs and illicit drugs.

This guideline have led to the FDA to issue black box warnings to physicians, which are the highest level warning that can be given out to clinicians.  They hope that the warning will help clinical staff to at least think twice when prescribing opiates for pain relief.

Although there has been a large push back on the actions of the CDC and the FDA by the pharma industry, it seems the regulations on opiates will continue to grow.  The recent death of the singer Prince, who died of a fatal dosage of opiates and benzodiazepines has pushed legislators to pay attention to the opiate epidemic.

In response to the local issues of metro detroit, we at MDADS have started a 12 week prescription pill educational group with a strong emphasis on the dangers of opiates.  Our educational group feature 1on1 sessions with Licensed counselors, group classes and random drug testing.  We believe that a combination of education, accountability and individual therapy will help our clients recover from the extreme addition that takes place with opiates.  For more informtion about our progrmas please visit www.micounselinggroup.com or contact us at info@micounselinggroup.com.

Also for more information on the CDC study can be found at:

http://jama.jamanetwork.com/article.aspx?articleid=2503508

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