Over the past 10 years, there have been some major changes in the rules for prescribing narcotic pain medications.
In the early 1980s, when I was in medical school, very few narcotics were prescribed except for cases of acute pain (surgery, broken bones), cancer pain and people on hospice care.
Then some studies came out that said that people getting narcotics for chronic pain did not become addicted, and at conferences we were taught that people who were acting addicted were actually pseudo-addicted because they weren’t getting enough pain medication. This was being taught to primary-care providers, emergency-room doctors and surgeons at our medical education update conferences. Since providers want to do the best thing for their patients, the number of narcotic pain medication prescriptions increased dramatically.
Unfortunately, that part about people with pain not becoming addicted to the medication wasn’t true. It turns out that about one in four people taking narcotic pain medication are in fact becoming addicted.
I put together some headlines in order of publication date (see sidebar) to show how quickly the information has changed. In only seven years, we went from “pain is undertreated” to “a wave of overprescribing.”
Now, more people are dying every year from opiate overdose than from car accidents, and many of them are getting the medication legally or from friends and family members who are getting it legally.
Some statistics on overdose deaths caused by narcotic pain pills from the U.S. Centers for Disease Control and Prevention website showed that:
• In 2014, 40 percent of drug-poisoning deaths involved opioid analgesics (18,893 deaths).
• The age-adjusted rate for deaths involving opioid analgesics nearly quadrupled, from 1.5 per 100,000 in 2000 to 5.9 per 100,000 in 2014.
• Nearly 65 percent of all deaths from opioid analgesics in 2014 involved natural and semisynthetic opioid analgesics, such as hydrocodone, morphine and oxycodone.
Also, newer studies are showing that the pain relief from narcotics is temporary, but the dependency is not.
So the pendulum is swinging back the other way. The U.S. Food and Drug Administration (FDA) is putting black-box warnings on all fast-acting opiates, highlighting the risks for abuse, addiction, overdose and death.
Now, if you are a patient taking opiate-based pain medication, you might say, “But I am one of those three in four who don’t have [addiction] problems.” And probably you are. But the rules are going to apply to everyone, because there is no test that shows precisely who is going to have problems.
Did opiate prescribing go too far? Yes, since it was based on the information we had 10 years ago, it did. Will opiate restriction probably go too far? Yes, since we must base it on the information we have now, it probably will. But eventually we will hit the right balance, as we learn more about it.
Pain Medication in the Headlines
“A Guide to the Safe Use of Pain Medication,” on the FDA website
Summary: According to the National Institutes of Health, studies have shown that properly managed medical use of opioid analgesic compounds (taken exactly as prescribed) is safe, can manage pain effectively, and rarely causes addiction.
January 5, 2010
Pain management failing as fears of prescription drug abuse rise
Summary: Millions of Americans with significant or chronic pain associated with their medical problems are being undertreated as physicians increasingly fail to provide comprehensive pain treatment—either due to inadequate training, personal biases or fear of prescription drug abuse.
October 16, 2012
Young people driving epidemic of prescription drug abuse, study finds; Abuse of nonmedical analgesics up 40 percent
Summary: A new study reveals that today’s adolescents are abusing prescription drugs at a rate 40 percent higher than previous generations. That makes it the second most common form of illegal drug use in the U.S., after marijuana.
February 4, 2015
Opioid and heroin crisis triggered by doctors overprescribing painkillers
Summary: Researchers said policymakers must look beyond painkiller abuse in their efforts to reduce opioid overdose deaths. New research reframes the heroin and prescription drug abuse problem as a wave of opioid addiction caused by overprescribing of painkillers by doctors.
March 24, 2015
Legally high? Teenagers and prescription drug abuse
Summary: Legal drugs such as OxyContin now kill more people than heroin and cocaine combined. While awareness of the dangers of illegal drugs has increased, many teens are still ignorant of the significant physical danger posed by legally prescribed drugs, according to a new study.
February 18, 2016
Health provider awareness can curb prescription drug abuse
Summary: Increasing health care providers’ level of concern about prescription drug abuse in their communities may be an effective public health tool in fighting America’s prescription drug abuse epidemic, according to a study.