0616 CNS Opioid 1

Pills In The Medicine Cabinet

Until recently, it was routine for many patients complaining of pain to get sent home from the doctor’s office with a prescription for weeks’ worth of painkillers. But now, new guidelines released this spring by the U.S. Centers for Disease Control are aiming to make those practices a thing of the past.

After a years-long spike in deaths from opioid addiction and overdoses, CDC officials are stepping in to limit access to heavy-duty painkillers like OxyContin, Percocet and Vicodin.

Overuse of those drugs is often a precursor to heroin use, which has spiked in recent years. In 2014, the United States hit a new record: More than 28,600 people died of opioid-related causes.

The new guidelines won’t affect patients who are prescribed painkillers after cancer treatment, or those receiving end-of-life care. Instead, the CDC is focusing in on drugs prescribed by primary care doctors.

What’s Changing?

One key change: Doctors will now be encouraged to start patients on shorter-acting pain solutions, like ibuprofen, before moving on to more serious drugs. And if opioid pain medications are needed, the CDC says doctors should prescribe just three days’ worth of medicine, instead of a week’s worth or more.

Jennifer Pruskowski, an assistant professor at the University of Pittsburgh School of Pharmacy and a palliative care clinical pharmacy specialist at the University of Pittsburgh Medical Center, says the changes will force doctors to personalize their pain management recommendations for patients, and consider other alternatives.

“The way the CDC wrote this, it’s a way for clinicians to circle back with you and see how are we doing in regards to your pain,” Pruskowski says. “Are you able to play with your grandchildren or take a walk with your wife?”

The recommendations also call for doctors to check prescription databases to ensure patients aren’t getting more of the drugs elsewhere. They are also asked to spend more time going over the risks and benefits of different types of pain management with patients.

Finding Alternatives

Pruskowski says it makes sense to look closer at the effects of opioid use on pain and on individual patients, though she says doctors face a tough task in figuring out how much pain people are in. She says medical professionals need more training in pain and pain management to make the right calls.

“It can be very difficult to ensure that the opiates they are using are working,” Pruskowski says.

“If doctors give you a blood pressure medication, you can expect your blood pressure to go down, and you can measure it. Pain is not like that.”

The recommendations, she says, could help encourage people to try alternative pain relief strategies, including physical therapy and acupuncture, which some people find very effective.

The challenge with these alternate techniques, Pruskowski says, is that they often take more time to be effective than prescription medications. Plus, many insurance companies are more likely to cover drugs than alternative therapies.

Patients can benefit by trying something different, if they’re willing to put in the effort and understand that the doctor will not just write a prescription and send them on their way. Most people are used to getting medicinal help.

“If you go to your physician and you are in pain, it’s difficult to wrap your head around the fact that there are other things than medication,” Pruskowski says. “We do a great job of advertising all these pills.”