Opioid Prescribing

Saving lives and ending the prescription drug overdose epidemic requires healthcare providers and patients to work together. Safe pain relief is important to the quality of life for millions of Americans.¹ A new CDC guideline recommends ways to reduce the risks of prescription opioid pain medications.

Drug overdose deaths reached record levels in 2014, and at least half of those deaths involved prescription drugs.² Opioids are the most common prescription drugs involved in these deaths. An opioid is a type of prescription drug used to treat moderate to severe pain. Brand names include Oxycontin, Vicodin, Opana, and others. From 1999 to 2014, more than 165,000 people died from overdose related to prescription opioids.³

Prescription opioid sales have quadrupled in the United States since 1999, and so have the number of deaths from prescription opioid overdoses.⁴ However, the overall amount of pain Americans report has not changed.⁵There have not been long term studies demonstrating that opioids control chronic pain effectively. Many people become tolerant to opioids and require higher amounts of the drug and approximately 2 million in the United States abuse or become addicted to opioids.

How can we help those in pain?

Patients with chronic pain deserve safer and more effective pain management. Healthcare providers want to do what’s best for their patients, but many have not received formal training in this area and may not be aware of options for managing long term pain. CDC developed the CDC Guideline for Prescribing Opioids for Chronic Pain⁶ to help providers make informed decisions about how to better serve patients with chronic pain. The guideline is designed to help providers and patients—together—assess the risks and benefits of opioid use.

Who should use the guideline?

The guideline is intended for primary care providers who are treating adult patients for chronic pain in outpatient settings. The guideline does not address pain management during active cancer treatment, palliative care, or end-of-life-care. Key recommendations include:

• Nonopioid therapy (such as exercise, nonopioid medications like NSAIDs, or cognitive behavioral therapy) is preferred for chronic pain outside of active cancer, palliative, and end-of-life care.
• When opioids are used, providers should prescribe the lowest effective dosage to reduce risks of addiction and overdose.
• Providers should work with patients to establish goals for pain treatment, and follow-up regularly to check on progress and watch for potential harm.

How will the guideline impact me?

The new prescribing guideline gives providers recommendations to help them make informed prescribing decisions for chronic pain management. CDC encourages providers to consider the unique needs of each patient in order to provide safer, more effective pain treatment while reducing risks of addiction and overdose. Know your options and talk to your doctor about ways to manage your pain that don’t involve prescription opioids. Some of these options may actually work better and have fewer risks and side effects.

What can I do?

• If you have chronic pain, talk to your provider about ways to manage it without opioids. Nonopioid medications, such as acetaminophen or ibuprofen, as well as physical therapy and exercise can be good options.
• If you use opioids:
  • Never take opioids in greater amounts or more than prescribed.
  • Avoid taking opioids with alcohol or drugs you haven’t discussed with your provider.
  • Keep your medications in a secure place. Do not share your medication with anyone.
  • Do not take any medication not prescribed to you.
  • Follow up with your provider regularly to discuss your progress.

References

1. Institute of Medicine Report from the Committee on Advancing Pain Research, Care, and Education: Relieving Pain in America, A Blueprint for Transforming Prevention, Care, Education and Research. The National Academies Press, 2011. Available from URL:
2. Centers for Disease Control and Prevention. National Vital Statistics System mortality data. (2014)
3. Centers for Disease Control and Prevention. WONDER mortality data. (2014)
4. Centers for Disease Control and Prevention. National Vital Statistics System mortality data. (2014)
5. Chang H, Daubresse M, Kruszewski S, et al. Prevalence and treatment of pain in emergency departments in the United States, 2000 – 2010. Amer J of Emergency Med 2014; 32(4): 421-31.

6. Centers for Disease Control and Prevention. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. MMWR 2016; (Early Release) 65;1-50.