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 "Overprescribing opioids, largely for chronic pain, is a key driver
of America's drug-overdose epidemic," said CDC Director Tom Frieden.
Sales of the prescription therapies have quadrupled since 1999,
causing 165,000 fatal overdoses over the same period and now growing
at more than 40 per day, according to the agency.
Primary care doctors who treat adults for chronic pain in outpatient
settings account for nearly half of all opioid prescriptions, the
CDC said. It defined chronic pain as lasting longer than three
months, or past the typical time it takes for normal tissue healing.
The new guidelines recommend non-opioids, including acetaminophen
and ibuprofen, as preferred therapy for chronic pain unless patients
have active cancer or are receiving palliative or end-of-life care.
When opioids are used, the lowest possible dose should be prescribed
to reduce risks of opioid abuse and overdose and patients should
then be closely monitored, according to the CDC guidelines. The
drugs should also be combined with non-drug approaches to
controlling pain, like physical therapy and exercise, the agency
said.
Moreover, when starting opioid therapy for chronic pain, doctors
should prescribe immediate-release formulations instead of
long-acting versions, the guidelines say. They recommend doctors
avoid prescribing opioids with sedatives called benzodiazepines.
When prescribed for acute, or short-term pain, doctors should
prescribe the lowest effective dose of immediate release opioids.
"Three days or less will often be sufficient; more than seven days
will rarely be needed," the guidelines say.
Some studies suggest only 5 percent of patients prescribed opioids
receive them for chronic pain, but they account for 70 percent of
overall opioid prescriptions and the majority of overdoses.
For the vast majority of patients taking opioids for chronic pain,
risks from the drugs will outweigh benefits, Frieden said.
"The prescription overdose epidemic is doctor-driven," Frieden said,
adding it can be reversed if doctors rein in their prescriptions of
the painkillers.
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The American College of Physicians on Tuesday said the new
guidelines provide important guidance "at a time when many
communities are being devastated by the adverse impact of opioid
misuse."
The most widely used opioids include hydrocodone, which is the main
active ingredient of Vicodin, and oxycodone, an active ingredient of
OxyContin and Percocet. They are synthetic narcotics which work by
binding to opioid receptors in the brain and are mostly available in
pill form.
Nearly two million Americans aged 12 or older either abused or were
dependent on prescription opioids in 2014, the CDC said.
Opioids also include heroin, an illegal injectable drug which has
become a far cheaper alternative to oral opioids on the streets of
many U.S. communities, causing many overdoses.
Other U.S. health officials on Tuesday said first responders should
have wider access to Naloxone, a drug that can reverse opioid
overdoses.
(Reporting by Ransdell Pierson, editing by G Crosse and Chizu
Nomiyama)
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