The most prescribed drugs in America are not antibiotics, heart medications or statins. Painkillers are the most filled prescription, a fact that is also leading doctors and the Food and Drug Administration (FDA) to take a clearly needed new look at pain management.
Doctors in the U.S. wrote approximately 180 million prescriptions for oxycodone and hydrocodone in 2013. That translates to about one prescription per adult in the country. Overdoses or misuse of those and other painkillers with opioids (such as morphine and codeine) kill an average of 46 people and send 1,150 to emergency rooms daily, according to the U.S. Centers for Disease Control and Prevention (CDC).
For years the FDA underplayed the problem and put off any tightening of regulations or refills. In fact, they just approved Zohydro, another hydrocodone medication – against the recommendation of their own experts.
Doctors are also questioning the practice of prescribing addictive painkillers for chronic problems. For example, the American Academy of Neurology (AAN) issued a new position in their journal Neurology, proclaiming that the negative effects of opioid painkillers outweigh any potential benefits to patients trying to manage chronic conditions like fibromyalgia and back pain.
The neurologists note that more than half of those who take opioids for three months wind up still taking them after five years. It was not always like that. Until the late 1990s, many states reportedly prohibited prescriptions for opioid painkillers for longer than three months to manage chronic pain, with the exception of cancer. However, after an early case study suggested the painkillers could be taken safely in the long term, pain advocacy groups successfully lobbied for the time limit to be lifted.
Now, the AAN suggests that the regulations became too permissive. They even cited an FDA ruling that disciplinary action will not be taken against doctors because of the frequency or quantity of opioids they prescribed.
Amid rising criticism as well as the addiction and overdose problems, the FDA is being pushed to take action. The FDA reportedly maintains that the problem lies in the hands of the doctors who are inappropriately prescribing the drugs and patients who use them improperly. In 2012, the federal agency began requiring makers of extended-release opioids to educate prescribers about potential risks from the drugs. They also tightened the paperwork required, as anyone who has filled a prescription for them in the last year or two can attest.
The AAN and some other organizations recommend using state Prescription Drug Monitoring Programs to monitor the prescription drugs being taken. This will identify patients who may be going to multiple doctors to get prescriptions.
The AAN suggests that physicians periodically assess effectiveness, consult a pain management specialist for patients who require a daily morphine-equivalent dosage of 80-120 mg with no signs of improvement and create an opioid prescription treatment agreement. To avoid abuse, patients should be periodically screened for depression and current or past drug abuse. These recommendations are not new but doctors have not been following them. Clearly the drug manufacturers do not want to see action taken. But, given the magnitude of the usage/abuse prescription painkiller problem, a new look at the painkillers, their usage and tracking by the FDA and doctors is needed.
By Dyanne Weiss