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Tuesday, March 15, 2016

Overly protective CDC issues new guidelines on opiate prescribing to reduce abuse, overdoses

The Centers for Disease Control and Prevention warned doctors Tuesday to use caution when prescribing drugs for chronic pain and to carefully monitor patients using the medications, as part of an effort to reduce addiction and overdoses.
article by Liz Szabo for USA Today | March 15, 2016
The USA is in the grips of an epidemic of prescription painkiller abuse, with 40 Americans a day dying from overdoses, according to the CDC. In 2013, an estimated 1.9 million people abused or were dependent on prescription opiates, drugs in the same class as morphine.

Nearly all of the prescription opiates on the market are as powerful as heroin, said CDC director Thomas Frieden. Yet prescription opiates often do a very poor job in controlling chronic pain. Some patients who are prescribed opiates actually experience more pain than others, Frieden said. For the vast majority of patients with chronic pain, the risks aren't worth the benefits, he said.

"We know of no other medication used for non-fatal conditions that kills patients so frequently," Frieden said. "We hope to see fewer deaths from opiates. That's the bottom line. These are really dangerous medications that carry the risk of addiction and death."

The hard line on opiates is a major shift from conventional wisdom about relieving pain. For decades, doctors were told to consider pain as a vital sign that needed to be addressed.

The CDC's 12 news guidelines are intended for primary care physicians, who prescribe more than half of opiates.

The recommendations aim to help doctors determine when to begin or continue opiates for chronic pain; how to choose opiates and for how long; and how to value the risk and harms of opiates. The recommendations, which doctors aren't legally obligated to follow, don't apply to the treatment of patients being treated for cancer or those receiving palliative or end-of-life care.

When treating chronic pain, doctors should use therapies other than opiates first, such as exercise or non-steroidal anti-inflammatories, such as ibuprofen, Frieden said.

Doctors should only prescribe opiates when they expect the benefits to outweigh the risks. Before starting opiates, doctors should talk to patients about their treatment goals and when to stop using opiates. Doctors should avoid prescribing opiates, which include drugs such as Vicodin and OxyContin, at the same time as benzodiazepines, which include the anti-anxiety drugs Valium and Xanax.

When doctors do prescribe opiates, they should use the lowest effective dose for the shortest amount of time, Frieden said. Patients with acute pain, such as that caused by an injury, usually don't need prescription opiates more than three days. "When opiates are used, start low and go slow," Frieden said, meaning that doctors should increase the dose of medication slowly and only when really needed.

Doctors should check every three months to see if the benefits of opiates still outweigh the risks, according to the guidelines.

If patients abuse opiates, doctors should help them get treatment that's supported by strong medical evidence, such as the therapies buprenorphine or methadone, according to the guidelines.

Patients should ask questions if their doctors want to prescribe them opiates, said Deborah Dowell, senior medical adviser in the division of unintentional injury prevention at the CDC’s National Center for Injury Prevention and Control. Key questions to ask include: Is an opiate necessary? What are the risks? What are the benefits? How long should I take this? Are there alternatives? What we hope to accomplish by using an opiate? How will you know when we've met our goal?


If medical professionals had been actual using common sense when prescribing medication to patients, would those of us that are able to live our lives with needed pain medications have to deal with now overly protective medical "professinal" now that are protecting there own asses now?...

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