In 2012, Americans received nearly 260 million prescriptions for opiate painkillers. Now, the National Institutes of Health (NIH) has released a white paper that reports “a dire need for research” to make up for the “scant” evidence that opioid painkillers should be used to treat chronic pain.
The NIH white paper condenses the final work of a seven-member panel that was convened in September to study the place of opioids in medicine. That panel, comprising independent experts in psychiatry, epidemiology and other disciplines, wrote in its full report that “the prevalence of chronic pain and the increasing use of opioids have created a ‘silent epidemic’.”
“The overriding question,” the panel wrote, “is whether we, as a nation, are currently approaching chronic pain in the best possible manner that maximizes effectiveness and minimizes harm.”
There is not nearly enough good research to say for sure, the experts said, writing: “Evidence is insufficient for every clinical decision that a provider needs to make about the use of opioids for chronic pain.”
That dearth of evidence combined with high numbers of substance abuse and overdose deaths in the US have created circumstances doctors need to confront immediately, the authors said.
By 2010, there were more than 160,000 hospitalizations a year for prescription opioid addiction. In 2012, healthcare providers wrote 259 million prescriptionsfor opioids, according to the Centers for Disease Control and Prevention (CDC). That year, more people aged 25 to 64 died from overdoses than car accidents.
The next year, 2013, the agency found that 71% of overdoses from prescription drugs – a total of 16,325 deaths – were caused by opioid painkillers. Last year, the CDC reported that doctors were a primary source of drugs for opioid abusers, and a doctor at the CDC estimated that 46 Americans died every day from overdoses of prescription painkillers.
Oxycodone, codeine, dilaudid and methadone are among the opiates most frequently abused; morphine is also often prescribed for patients who report extreme pain.
The new NIH white paper estimates that between five and eight million Americans take opioid painkillers to manage chronic long-term pain, but nearly all opiate drugs consumed for months and years were approved on the basis of 12-week studies.
Although people have consumed opioids to dull short-term pain for centuries, new research shows there are distinct kinds of physical pain, and that not all treatments work as effectively to manage them. The panel found that patients with chronic pain were too often “lumped into a single category”, even though humans have three distinct pain mechanisms, such as those caused by inflammation versus nerve damage or arthritis and cancer.
But experts told the panel almost unanimously that they feared physicians could not distinguish between people who were at risk or could be at risk to develop problems with misuse.
The health system itself encourages doctors to prescribe drugs, the panel noted, since many plans “nonopioid alternatives as second- or third-line options rather than placing them more appropriately as first-line therapy”.
“Important clinical tasks” have fallen by the wayside, the experts warned, in favor of seemingly easy answers such as prescriptions.
“In the case of pain management, which often requires substantial face-to-face time, quicker alternatives have become the default option.”
Ultimately, the NIH panel recommended that providers tailor treatment to each individual patient, and suggested “a multidisciplinary approach”, including a mix of physical therapy and non-drug options, “similar to that recommended for other chronic complex illnesses, such as depression, dementia, eating disorders or diabetes”.
Opioids can be very effective for some patients, the experts acknowledged, but even for those for whom the drugs work the panel recommended regular check-ups.
There is “a dire need for research on the effectiveness and safety of opioids”, the panel wrote, while also recommending an overhaul of the electronic health record system to better help doctors keep track of a patient’s medical history.
Worked with the Partnership of a Drug-Free New Jersey to create TalkNowNJ.com with some wonderful people to spread awareness on the prescription drug epidemic. I am here with from the top left Steve Adubato, Meg Dupont Parisi, Angelo Valenti, Myself and Donna Pacicco DeStefano.
Please take 15 minutes to learn about what you can do to know if someone you love is addicted to RX drugs.
Over the past two decades, the number of prescriptions for opiate-based painkillers has tripled, while dosages have grown stronger
Elaine and Steve Pozycki
The prime source for the national explosion of opiate addiction — whether in the form of painkillers such as OxyContin or in the form of illegal street drugs such as heroin — is the dramatic increase in the use of opiate-based prescription drugs. Over the past 20 years, there has been a threefold increase in the number of prescriptions issued for opiate-based painkillers, as well as a major step-up in dosage, according to the Centers for Disease Control and Prevention (CDC). Healthcare providers wrote 259 million prescriptions in 2012 alone. Further, it has been well-documented that some people when they can no longer get access to prescription painkillers feed their opiate addiction by turning to heroin.
The costs in lost and ruined lives from what the CDC refers to as a “national epidemic” of opiate addiction continue to rise. Drug overdoses are the number one cause of accidental death in the United States. In 2010, nearly 20,000 people died from an overdose of opiates — nearly 17,000 from prescription painkillers and an additional 3,000 from heroin. It is time for a comprehensive approach that matches the scale of the problem and that begins at its source—the overprescribing of prescription painkillers and the underinforming of patients about the risks of this medication and possible alternatives
We are pleased to report that there is legislation moving through the New Jersey legislature that does exactly that. Senator Loretta Weinberg (D-37th) and Senator Joe Vitale (D-19th) are putting forward a proposed law (S-2366) requiring physicians and other health practitioners to discuss with a patient the risks of physical and psychological addiction and the availability of potential alternative medications, before issuing a prescription for an opiate-based painkiller.
In cases where the patient is under 18 years old, this discussion must take place with a parent or a guardian From the harm that too many of our children and families have experienced because a teenager becomes addicted to opiates, we know just how important providing this essential knowledge can be. To ensure compliance with the essential provisions of this legislation, the practitioner must obtain a written acknowledgement from the patient or the patient’s parent or guardian that this discussion has taken place.
The need for moving forward with this kind of approach is underscored by the American Academy of Neurology’s recent determination that the risks of powerful narcotic painkillers outweigh their benefits for treating chronic headaches, low back pain, and fibromyalgia. The Academy noted that 50 percent of patients who took opioids for at least three months are still on them five years later.
Further, more appropriate and limited prescribing of prescription painkillers will help reduce heroin use by reducing the number of people who crave opiates. AS CDC Director Tom Frieden, M.D., M.P.H., said, “Addressing prescription opioid abuse by changing prescribing is likely to prevent heroin use in the long term
Just as importantly, there is strong public support in New Jersey for this approach. In a recent FDU Public Mind Poll, more than two-out-of-three New Jersey parents indicated support for a law requiring that they be notified if their child’s prescription contained potentially addictive medication
We are pleased to report that this legislation, one component of a comprehensive package aimed at taking on New Jersey’s addiction problem passed the Senate recently, by a margin of 36 to 1. Still, there is a long way to go before final passage and it will require all of us to make our voices heard. It is particularly important for people to communicate their support to their Assembly members, since that is the next hurdle, we anticipate an open and fair discussion of this legislation in the Assembly Health Committee chaired by Assemblyman Herb Conaway (D-7th) soon after the New Year.
Senator Weinberg and Vitale’s legislation (S-2366 ) is a critical prevention measure which attacks the problem directly at its source. Treatment after the fact is still important to do, but because of the brain changes caused by opiate addiction, it is a hard, difficult road to recovery for too many and the results are hit or miss. We must put preventing addiction in the first place at the forefront and that begins with passing this essential measure.
Elaine and Steve Pozycki are board members of the Partnership for a Drug-Free New Jersey, with Elaine serving as co-chair. Steve Pozycki is the founder, chairman, and CEO of SJP Properties.
The New Year always brings change for each one of us. One thing that we don’t have control over time moving on. Yet, the things that we do have control over we need to stay focused on to better ourselves and the world around us.
I haven’t posted in a while. I have been busy continuing my education. I have returned to school as a full time student and it has consumed 8 days of week of work. In order for me to make a difference in my advocacy movements, I want to gain as much education as I can. So I apologize for slacking, however will do my best in 2015!!!
