Close X
Thursday, November 14, 2024
ADVT 
Health

What Patients Can Do When Doctors Opt For Risky Painkillers

Darpan News Desk The Canadian Press, 16 Mar, 2016 01:21 PM
    NEW YORK — New federal guidelines are out for doctors who prescribe powerful prescription painkillers, aimed at curbing their abuse and addiction. Experts say there are things patients can do to guard against problems.
     
    The voluntary advice from the Centers for Disease Control and Prevention is for primary care doctors, not for specialists treating severe pain from cancer or other diseases.
     
    TALK TO YOUR DOCTOR
     
    Learn about the drugs first, and don't be afraid to ask a lot of questions. "Beginning treatment with an opioid is a momentous decision," and can carry more risks than benefits, said CDC director Dr. Tom Frieden.
     
    TRY OTHER OPTIONS FIRST
     
    Consider other ways to manage pain. Physical therapy, psychological therapy, and exercise can help in some situations. So can other medications, like acetaminophen or ibuprofen.
     
     
    START LOW, GO SLOW
     
    If you need powerful painkillers like OxyContin or Vicodin, start with the lowest effective dose for a limited period. Experts say risks increase with the dosage and the length of time a patient is taking the drugs.
     
    BEWARE A DRUG MIX MENACE
     
    Make sure your doctor knows if you are taking Valium, Xanax or other benzodiazepine sedatives for anxiety, insomnia or other conditions. Opioids and benzodiazepines can be a particularly dangerous combination.
     
    SET A LIMIT
     
    Agree on a timetable with your doctor for evaluating the benefits and harms of the drugs. Opioids often are needed no longer than a week for acute pain. And often they are a bad choice for chronic pain, Frieden said.
     
    CDC GUIDELINES AIM TO CURB PAINKILLER PRESCRIBING
     
    WASHINGTON — Prescription painkillers should not be a first choice for treating common ailments like back pain and arthritis, according to new federal guidelines designed to reshape how doctors prescribe drugs like OxyContin and Vicodin.
     
    Amid an epidemic of addiction and abuse tied to these powerful opioids drugs, the Centers for Disease Control and Prevention is urging primary care doctors to try physical therapy, exercise and over-the-counter pain medications before turning to painkillers for chronic pain. Opioid drugs include medications like morphine and oxycodone as well as illegal narcotics like heroin.
     
    The new recommendations — which doctors do not have to follow — represent an effort to reverse nearly two decades of rising painkiller use, which public health officials blame for a more than four-fold increase in overdose deaths tied to the drugs. In 2014, U.S. doctors wrote nearly 200 million prescriptions for opioid painkillers, while deaths linked to the drugs climbed to roughly 19,000 — the highest number on record.
     
     
    "We're trying to chart a safer and more effective course for dealing with chronic pain," Dr. Tom Frieden, the CDC's director, said in an interview with the Associated Press. "The risks of addiction and death are very well documented for these medications."
     
    More than 40 Americans die every day from painkiller overdoses, a staggering rate that Frieden said is "doctor driven."
     
    Under the new guidelines, doctors would prescribe painkillers only after considering non-addictive pain relievers, behavioural changes and other options. The CDC also wants doctors to prescribe the lowest effective dose possible. And doctors should only continue prescribing the drugs if patients show significant improvement.
     
    For short-term pain, the CDC recommends limiting opioids to three days of treatment, when possible.
     
    The guidelines do not apply to doctors who specialize in treating severe pain due to cancer and other debilitating diseases.
     
    Though the guidelines are voluntary, they could be widely adopted by hospitals, insurers and state and federal health systems.
     
    Government officials have already tried multiple approaches to tackling painkiller abuse. The Food and Drug Administration restricted some widely-prescribed painkillers to limit refills. States like Florida and New York have cracked down on "pill mills" using databases to monitor what doctors are prescribing. And this week, Massachusetts signed into law a seven-day limit on first-time prescriptions for opioids — the first of its kind in the nation.
     
     
    "Changing medical practice isn't quick and it isn't easy," Frieden said. "But we think the pendulum on pain management swung way too far toward the ready use of opioids."
     
    The CDC rarely advises physicians on how to prescribe medications — a role typically delegated to professional societies and drug regulators.
     
    FDA labeling for the drugs is broad, listing uses like "relief of moderate to severe pain." Guidelines by pain specialists provide more detail, but focus less on risks. The CDC guidelines put such warnings upfront: "Opioids are not first-line therapy," states the agency's first recommendation.
     
    Local health authorities applauded the CDC for weighing in on the problem they face in their communities.
     
    "The CDC is a respected source of information. Their guidelines carry weight," said Baltimore City Health Commissioner Dr. Leana Wen.
     
    But some leading medical groups stopped short of embracing the recommendations. 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" said Dr. Patrice Harris, in a statement. "They are not the final word."
     
    In many ways, the guidelines are a return to older medical practice. Physicians trained in the 1960s and 1970s — amid a wave of urban heroin use — were taught to reserve opioids for the most severe forms of pain, such as cancer or end-of-life care. That approach remains accepted.
     
    But in 1990s, some specialists argued that doctors were undertreating common forms of pain that could benefit from opioids, such as backaches and joint pain. The message was amplified by multimillion-dollar promotional campaigns for new, long-acting drugs like OxyContin, which was promoted as less addictive.
     
    OxyContin's maker, Purdue Pharma, later agreed to plead guilty for misleading the public about the drug's risks.
     
    "A whole generation of physicians grew up thinking they could use opiates pretty liberally," said Dr. Bruce Psaty, a professor at the University of Washington who also advises the FDA. "We are now in the process of re-educating ourselves and our patients."
     
    Physicians must now find a "comfortable balance," Psaty said, using opioids carefully while making sure patients don't go untreated.
     
    The CDC delayed its guidelines earlier this year following criticism from pain specialists, drugmakers and others.
     
    Critics complained that the recommendations went too far and had mostly been developed behind closed doors by physicians who are biased against drug therapy. Instead of releasing the guidelines in January, as originally planned, the CDC agreed to re-open them to public input, receiving more than 4,000 comments over a 30-day period.
     
    Critics said the proposal could block patient access to medications if adopted by health providers, insurers and hospitals. Such organizations often look to the federal government for health care policies.
     
    Last week, an early sign of the guideline's impact surfaced in the Senate. Lawmakers there overwhelmingly passed a bill designed to combat opioid abuse, including a provision requiring the Veterans Administration to adopt the CDC recommendations.

    MORE Health ARTICLES

    Zika Infections Confirmed In 9 Pregnant Women In US

    Zika Infections Confirmed In 9 Pregnant Women In US
    The Centers for Disease Control and Prevention said Friday that it is also investigating 10 additional reports of pregnant travellers with Zika.

    Zika Infections Confirmed In 9 Pregnant Women In US

    Public Health Agency Says 14 Travel-Related Cases Of Zika Virus In Canada

    The latest confirmed case is in Saskatchewan and other cases have been confirmed in Ontario, Alberta and B.C.

    Public Health Agency Says 14 Travel-Related Cases Of Zika Virus In Canada

    Edmonton Hospital Performing Record Number Of Lung And Liver Transplants

    Edmonton Hospital Performing Record Number Of Lung And Liver Transplants
    They performed 83 liver transplants, besting the previous record of 80 set in 2007, and 22 of those were transplants involving living donors.

    Edmonton Hospital Performing Record Number Of Lung And Liver Transplants

    Health Canada Warns Cancer Pill Sold Online Could Release Cyanide When Ingested

    Health Canada Warns Cancer Pill Sold Online Could Release Cyanide When Ingested
    Health Canada says Novodalin B17 "poses serious risks to health" because it purportedly contains apricot kernel extract.

    Health Canada Warns Cancer Pill Sold Online Could Release Cyanide When Ingested

    Small Study Suggests Zmapp May Boost Ebola Virus Survival

    Small Study Suggests Zmapp May Boost Ebola Virus Survival
    A tiny study may suggest that the experimental Ebola treatment ZMapp sharply increases the chance of surviving the virus.

    Small Study Suggests Zmapp May Boost Ebola Virus Survival

    14 More US Reports Of Possible Zika Spread Through Sex

    14 More US Reports Of Possible Zika Spread Through Sex
    The 14 cases all involve men who visited areas with Zika outbreaks, and who many have infected their female sex partners, who had not travelled.

    14 More US Reports Of Possible Zika Spread Through Sex