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The benefits of prescribing opioids to patients with some chronic noncancer pain conditions such as headache, fibromyalgia, and chronic low back pain are offset by the severity of the risks inherent to taking those drugs, according to new position paper published by the American Academy of Neurology.
Opioids such as morphine, codeine, oxycodone, methadone, fentanyl, and hydrocodone have become commonly associated with a high risk of addiction, overdosing, and sometimes death. These are key reasons why new protocols are urgently needed to help curb the growing problem, said Dr. Gary M. Franklin, a neurologist and research professor in the department of environmental and occupational health sciences at the University of Washington, Seattle.
“The language in these [opioid] laws implying no ceiling on dose, or placing no limits on dispensing controlled substances from prescriber offices, should be revisited in the context of the benefits, morbidity, and mortality,” Dr. Franklin wrote (Neurology 2014;83:1277-84).
Since the late 1990s, when policy changes allowed for more liberal long-term use, there have been more than 100,000 deaths related to prescription opioids. At Washington State Hospital alone, hospitalizations due to opioid overdoses skyrocketed between 1995 and 2008, growing from well under 100 per year to over 400.
Studies also indicate that about half of all patients who take opioids for 3 months to treat chronic pain continue to use the drugs as much as 5 years later. In fact, within the age group of 35-54 years, opioid-related mortality has exceeded deaths caused by both motor vehicle accidents and firearms since the late 1990s.
In an interview, Dr. Franklin advised physicians to be very careful about using opioid therapy as a first-line treatment for mild to moderate pain conditions. If it is used at all, it should be for only a few days. For patients who are already on high doses of opioids, Dr. Franklin recommended that physicians consult guidelines on tapering and help patients find a therapy without the risks of chronic opioid treatment.
“You should not abandon your patients,” he said. “You might decide not to keep using opioids, but don’t abandon the patient. Offer them some other things that might help them.”
The overprescribing of opioids has been slow to turn around, Dr. Franklin said, because physicians lack alternatives and in many cases it is easier to simply write a prescription. Potentially helpful alternative treatments such as cognitive behavior therapy or multidisciplinary pain care are not always covered by insurers, he said.
“I feel like there has been a tipping point, but that still doesn’t mean that it’s going to reverse soon,” he added. “There’s still going to be a lot of lives lost.”
In the position statement, Dr. Franklin proposed a regimen for doctors that could help limit the amount of opioids prescribed, the length of such treatments, and their misuse. This would include a patient-doctor opioid treatment agreement, prescreening for past drug abuse and depression, random urine testing, abiding by state Prescription Drug Monitoring Programs, and strict avoidance of sedative-hypnotics and benzodiazepines. The American Academy of Neurology recommends that all doctors consult with a pain management specialist before prescribing morphine-equivalent dosages of 80-120 mg/day.
Although measures have been taken by U.S. government agencies to crack down on long-term opioid prescriptions – such as the 2007 Risk Evaluation and Mitigation Strategies implemented by the Food and Drug Administration and the Drug Enforcement Agency’s 2010 decision to restrict e-prescribing of opioids – Dr. Franklin said that there is still much to be done.
“Ongoing research and data collection regarding opioid efficacy and management are needed, as well as revision in state and federal laws and policy” to ensure patient safety, Dr. Franklin wrote.
He reported no relevant financial disclosures.
The benefits of prescribing opioids to patients with some chronic noncancer pain conditions such as headache, fibromyalgia, and chronic low back pain are offset by the severity of the risks inherent to taking those drugs, according to new position paper published by the American Academy of Neurology.
Opioids such as morphine, codeine, oxycodone, methadone, fentanyl, and hydrocodone have become commonly associated with a high risk of addiction, overdosing, and sometimes death. These are key reasons why new protocols are urgently needed to help curb the growing problem, said Dr. Gary M. Franklin, a neurologist and research professor in the department of environmental and occupational health sciences at the University of Washington, Seattle.
“The language in these [opioid] laws implying no ceiling on dose, or placing no limits on dispensing controlled substances from prescriber offices, should be revisited in the context of the benefits, morbidity, and mortality,” Dr. Franklin wrote (Neurology 2014;83:1277-84).
Since the late 1990s, when policy changes allowed for more liberal long-term use, there have been more than 100,000 deaths related to prescription opioids. At Washington State Hospital alone, hospitalizations due to opioid overdoses skyrocketed between 1995 and 2008, growing from well under 100 per year to over 400.
Studies also indicate that about half of all patients who take opioids for 3 months to treat chronic pain continue to use the drugs as much as 5 years later. In fact, within the age group of 35-54 years, opioid-related mortality has exceeded deaths caused by both motor vehicle accidents and firearms since the late 1990s.
In an interview, Dr. Franklin advised physicians to be very careful about using opioid therapy as a first-line treatment for mild to moderate pain conditions. If it is used at all, it should be for only a few days. For patients who are already on high doses of opioids, Dr. Franklin recommended that physicians consult guidelines on tapering and help patients find a therapy without the risks of chronic opioid treatment.
“You should not abandon your patients,” he said. “You might decide not to keep using opioids, but don’t abandon the patient. Offer them some other things that might help them.”
The overprescribing of opioids has been slow to turn around, Dr. Franklin said, because physicians lack alternatives and in many cases it is easier to simply write a prescription. Potentially helpful alternative treatments such as cognitive behavior therapy or multidisciplinary pain care are not always covered by insurers, he said.
“I feel like there has been a tipping point, but that still doesn’t mean that it’s going to reverse soon,” he added. “There’s still going to be a lot of lives lost.”
In the position statement, Dr. Franklin proposed a regimen for doctors that could help limit the amount of opioids prescribed, the length of such treatments, and their misuse. This would include a patient-doctor opioid treatment agreement, prescreening for past drug abuse and depression, random urine testing, abiding by state Prescription Drug Monitoring Programs, and strict avoidance of sedative-hypnotics and benzodiazepines. The American Academy of Neurology recommends that all doctors consult with a pain management specialist before prescribing morphine-equivalent dosages of 80-120 mg/day.
Although measures have been taken by U.S. government agencies to crack down on long-term opioid prescriptions – such as the 2007 Risk Evaluation and Mitigation Strategies implemented by the Food and Drug Administration and the Drug Enforcement Agency’s 2010 decision to restrict e-prescribing of opioids – Dr. Franklin said that there is still much to be done.
“Ongoing research and data collection regarding opioid efficacy and management are needed, as well as revision in state and federal laws and policy” to ensure patient safety, Dr. Franklin wrote.
He reported no relevant financial disclosures.
The benefits of prescribing opioids to patients with some chronic noncancer pain conditions such as headache, fibromyalgia, and chronic low back pain are offset by the severity of the risks inherent to taking those drugs, according to new position paper published by the American Academy of Neurology.
Opioids such as morphine, codeine, oxycodone, methadone, fentanyl, and hydrocodone have become commonly associated with a high risk of addiction, overdosing, and sometimes death. These are key reasons why new protocols are urgently needed to help curb the growing problem, said Dr. Gary M. Franklin, a neurologist and research professor in the department of environmental and occupational health sciences at the University of Washington, Seattle.
“The language in these [opioid] laws implying no ceiling on dose, or placing no limits on dispensing controlled substances from prescriber offices, should be revisited in the context of the benefits, morbidity, and mortality,” Dr. Franklin wrote (Neurology 2014;83:1277-84).
Since the late 1990s, when policy changes allowed for more liberal long-term use, there have been more than 100,000 deaths related to prescription opioids. At Washington State Hospital alone, hospitalizations due to opioid overdoses skyrocketed between 1995 and 2008, growing from well under 100 per year to over 400.
Studies also indicate that about half of all patients who take opioids for 3 months to treat chronic pain continue to use the drugs as much as 5 years later. In fact, within the age group of 35-54 years, opioid-related mortality has exceeded deaths caused by both motor vehicle accidents and firearms since the late 1990s.
In an interview, Dr. Franklin advised physicians to be very careful about using opioid therapy as a first-line treatment for mild to moderate pain conditions. If it is used at all, it should be for only a few days. For patients who are already on high doses of opioids, Dr. Franklin recommended that physicians consult guidelines on tapering and help patients find a therapy without the risks of chronic opioid treatment.
“You should not abandon your patients,” he said. “You might decide not to keep using opioids, but don’t abandon the patient. Offer them some other things that might help them.”
The overprescribing of opioids has been slow to turn around, Dr. Franklin said, because physicians lack alternatives and in many cases it is easier to simply write a prescription. Potentially helpful alternative treatments such as cognitive behavior therapy or multidisciplinary pain care are not always covered by insurers, he said.
“I feel like there has been a tipping point, but that still doesn’t mean that it’s going to reverse soon,” he added. “There’s still going to be a lot of lives lost.”
In the position statement, Dr. Franklin proposed a regimen for doctors that could help limit the amount of opioids prescribed, the length of such treatments, and their misuse. This would include a patient-doctor opioid treatment agreement, prescreening for past drug abuse and depression, random urine testing, abiding by state Prescription Drug Monitoring Programs, and strict avoidance of sedative-hypnotics and benzodiazepines. The American Academy of Neurology recommends that all doctors consult with a pain management specialist before prescribing morphine-equivalent dosages of 80-120 mg/day.
Although measures have been taken by U.S. government agencies to crack down on long-term opioid prescriptions – such as the 2007 Risk Evaluation and Mitigation Strategies implemented by the Food and Drug Administration and the Drug Enforcement Agency’s 2010 decision to restrict e-prescribing of opioids – Dr. Franklin said that there is still much to be done.
“Ongoing research and data collection regarding opioid efficacy and management are needed, as well as revision in state and federal laws and policy” to ensure patient safety, Dr. Franklin wrote.
He reported no relevant financial disclosures.
FROM NEUROLOGY
