As an emergency room (ER) doctor and a public health researcher, I see the effects of pain as well as prescription opioid misuse and opioid use disorder on individual patients, families, and communities. In the ER, I've treated many types of patients -- from those who come in with fractured bones to patients who need long-term pain management. I've also seen patients after an overdose from prescription opioids. As a doctor, caring for the safety of patients is my top concern.
At CDC we have been tracking the growing epidemic of opioid overdoses for over a decade. What initially sparked our concern was a substantial increase in the number of deaths among adults from unintentional poisonings. Our country is still facing this significant public health problem and it's not getting better. Now that the National Rx Drug Abuse and Heroin Summit has come to an end, we have a great deal more to reflect on, there were many discussions about overdose deaths hitting record levels in 2014, with more than 28,000 people dying from opioid overdoses--from prescription opioid pain relievers and heroin.
Opioids are often prescribed following surgery or injury. In recent years, there has been a dramatic increase in the acceptance and use of prescription opioids for the treatment of chronic, non-cancer pain such as back pain or osteoarthritis. However, there is insufficient evidence that opioids control chronic pain effectively, and there is growing concern about the serious risks of addiction and overdose related to these drugs. There are also other treatments, such as exercise therapy and non-steroidal anti-inflammatory medications that can be more effective - with less serious risks.
The CDC Guideline for Prescribing Opioids for Chronic Pain was developed with the best, most recent evidence that is known about opioids. The guideline is a set of 12 recommendations for primary care providers on the use of opioids to treat chronic pain in adults that lasts longer than three months, or beyond the time of normal tissue healing during recovery. The guideline does not contain recommendations for patients in active cancer treatment, or in palliative or end-of-life care. Intended to be a helpful tool for physicians, it includes recommendations to:
• inform clinical decision making;
• encourage improved communication between clinicians and patients; and
• prescribe the lowest effective dose of immediate-release opioids when treating a patient with acute pain and not to prescribe more than is needed.
As a practicing physician, I routinely use guidelines to 'guide' my practice, and I take into account each patient's unique needs and treat each as an individual. The goal of the guideline is to help providers and patients -- together -- assess the benefits and risks of opioid use.
We know that opioids can help manage some types of pain, but they also have very serious risks of addiction and overdose. At CDC, we're doing everything in our power to eliminate the epidemic of opioid overdoses. We also believe that patients have a right to make informed decisions about treatment options. The guideline is a practical approach to achieving the goal of helping doctors and patients work together to manage chronic pain in a safer, more effective way.