Prescription Painkillers: New Guidelines Coming Soon?



Chronic pain sufferers might bemoan the fact that guidelines for prescription painkillers may be coming soon, but according to some doctors, they are sorely needed. In a position paper published by the American Academy of Neurology, Dr. Guy M. Franklin outlined the findings of a committee formed to study what he refers to as the, “Epidemic of prescription opioid-related morbidity and mortality in the United States.” It is the recommendation of the committee that guidelines for prescribing painkillers be established in order to prevent dangerous outcomes which can include addiction and even death.

Doctors generally prescribe opioids, also referred to as narcotic painkillers, to combat severe pain in cases where other kinds of pain relievers have proven ineffective. Some of the more common opiates prescribed for pain include Codeine, Morphine, Tramadol, Hydrocodone and Oxycodone. In the brain, opiates bind themselves to certain receptors effectively blocking the pain. Some people may also experience what is often described as a short period of euphoria or a warm floating sensation of being free, not only from pain but from fear or depression.

While narcotic painkillers have proven very effective in eliminating pain, people can easily become so desirous of experiencing that euphoric state that they continue taking the drugs after the pain is gone. Doctors agree that long-term use comes with the risk of addiction or overdose and there are some other hazards as well.

According to the position paper, published on Sept. 29, 2014, there is not a lot of evidence to support the long-term use of prescription painkillers. While short-term relief of chronic pain may be a good thing, the risks of taking prescription narcotic painkillers or opiates are far greater than the benefits. Dr. Franklin and his team are convinced that new guidelines for prescription painkillers cannot come soon enough. There is a huge risk of addiction as Dr. Franklin points out, “Fifty percent of patients taking opioids for at least 3 months are still on opioids 5 years later.”

There is also danger of overdose and death. In fact, as he states in the report, “Over 100,000 persons have died, directly or indirectly, from prescribed opioids in the United States since policies changed in the late 1990s.” He goes to add that for those aged 35 to 54, classified as high risk, this number exceeded the number of deaths caused by car accidents or firearms.

Proposed guidelines include screening patients for past or present substance abuse, depression or post-traumatic stress disorder (PTSD). Urine screening and increased monitoring of patients who have been prescribed pain killers to determine the level of drugs being used. and determining if patients are obtaining drugs from multiple sources is also suggested. The report also advised establishing a universal standard for maximum dosages and suggests that doctors only prescribe certain medications in close consultation with pain management specialists.

The report establishes very firmly that the side effects including the potential for abuse, addiction and death are not worth the risks of taking these medications especially not in the long-term. There is just not conclusive proof that long-term use contributes to a better quality of life. In fact, when considering the potential risks, most would probably agree that safe guidelines for the use prescription painkillers cannot come soon enough.

By Constance Spruill


National Institutes of Medicine

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