Pubdate: Thu, 17 Mar 2016
Source: New York Times (NY)
Copyright: 2016 The New York Times Company
Contact: http://www.nytimes.com/ref/membercenter/help/lettertoeditor.html
Website: http://www.nytimes.com/
Details: http://www.mapinc.org/media/298

A STRONG RESPONSE TO THE OPIOID SCOURGE

The Centers for Disease Control and Prevention this week released 
well-reasoned guidelines for how doctors should prescribe opioid 
painkillers. The voluntary standards could make a difference in 
curbing the alarming increase in prescription drug deaths.

In 2014, overdoses of opioids, like oxycodone and hydrocodone, and 
related drugs like heroin were responsible for 28,647 deaths, up 14 
percent from the year before. About one in 550 people who received 
opioids for chronic pain not linked to cancer died from an 
opioid-related overdose a median of 2.6 years after their first 
prescription. "We know of no other medication routinely used for a 
nonfatal condition that kills patients so frequently," Dr. Thomas 
Frieden and Dr. Debra Houry of the C.D.C. wrote in The New England 
Journal of Medicine on Tuesday.

To reduce this high toll, the C.D.C. is advising doctors not to 
prescribe opioids for chronic pain in most situations. Studies have 
found no evidence that the long-term use of opioids is beneficial, 
and in fact, exercise, physical therapy and over-the-counter drugs 
like acetaminophen can be more effective. The guidelines do not apply 
to cancer treatment, palliative care and end-of-life care, situations 
in which opioids are often the only way to reduce pain.

The guidelines also advise doctors prescribing opioids to start with 
low doses, prescribed for three days or less and rarely for more than 
seven days. Doctors should also clearly warn patients that the drugs 
are highly addictive and check prescription-monitoring programs to 
see if people are getting drugs from multiple physicians. Most states 
have such programs, but many do not require that doctors use them.

Though the guidelines are voluntary, they carry a lot of weight with 
doctors, hospitals, insurers and health regulators. The C.D.C.'s 
analysis is likely to influence how state governments develop laws 
and regulations for opioid prescriptions. Last month, the National 
Governors Association said it would create prescription protocols by 
July. Some states are already far along in this process. Gov. Charlie 
Baker of Massachusetts signed a law on Monday that forbids doctors 
from writing opioid prescriptions for more than a seven-day supply. 
Lawmakers in Vermont and Maine are considering similar laws.

There is more that could be done. Now that the C.D.C. says these 
drugs should not be used to treat chronic pain, the Food and Drug 
Administration should forbid the makers of opioids from marketing 
them to doctors for those purposes. There also needs to be more 
access to treatment for opioid addicts. The Senate recently passed a 
bill that authorizes treatment programs, but that legislation did not 
include adequate funding. President Obama has proposed spending $1.1 
billion on opioid abuse programs, with $920 million going to help 
states provide medication-assisted treatment, a plan Congress should support.

For far too long, the medical profession and policy makers ignored 
growing evidence that prescription painkillers were causing great 
harm. Now that abuse has become an epidemic, the government needs to 
mount a much stronger response to it.
- ---
MAP posted-by: Jay Bergstrom