Doctors should be more cautious about prescribing narcotic painkillers except in the most extreme cases, federal regulators announced Tuesday, in an attempt to slow down the nationwide epidemic of overdose deaths.
The U.S. Centers for Disease Control and Prevention urged physicians to have their patients try physical therapy, exercise and over-the-counter medicine before using opioids like Oxycontin and hydrocodone to treat chronic pain.
Prescriptions and sales of opium-derived painkillers have quadrupled since 1999. In 2014, U.S. doctors wrote nearly 200 million prescriptions for opioid painkillers, while deaths linked to the drugs climbed to a record of roughly 19,000.
The CDC now recommends using non-narcotic drugs except to treat active cancer and for palliative and end-of-life care, using the lowest effective dose of opioids and closely monitoring patients. For short-term pain, the CDC recommends limiting opioids to three days, when possible.
Critics said the guidelines could block patient access to medications if adopted as policy by health providers, insurers and hospitals.
But leading local pain management doctors said a push to reduce patients’ pain in the 1990s led to over-reliance on narcotics, in some cases encouraged by patient reviews of doctors. Now the pendulum is swinging back.
The specialists welcomed the guidelines as a first step to reducing narcotics abuse — noting that some patients stay on opioids for 20 or 30 years or more — but said more needs to be done.
Dr. Asokumar Buvanendran of the Rush Pain Center in Chicago said that primary physicians need to be made more aware of alternatives, such as epidural injections, radiofrequency denervation and spinal cord stimulation. He added that insurance companies should cover such treatments, though they often don’t.
“Used appropriately, opioids are an important tool in treating pain,” he said in a statement. “But there are very many safe, non-pharmacological and non-opioid pharmacological therapies proven to be as or more effective than opioids that don’t carry the risk of dependence.”
Patients and doctors should seek a holistic approach to treating pain, said Dr. David Dickerson, with University of Chicago Medicine, noting that painkillers can actually make symptoms worse over time.
Dr. David Walega, of Northwestern Medicine’s Department of Anesthesiology, said primary care providers should partner with pain specialists to see if a patient can try alternatives before taking prescription pills.
The American Medical Association, the largest professional group for physicians, cautioned that the guidelines could create problems if they steer patients toward pain treatments that aren’t accessible or covered by insurance.
“If they produce unintended consequences, we will need to mitigate them,” Dr. Patrice Harris said in a statement. “They are not the final word.”
Associated Press contributed.