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REDUCING THE PRESCRIPTION OF OPIOIDS

Every day, more than 115 people in the United States die after overdosing on opioids. The majority of people who develop an addiction to opioids start out with a legitimate prescription for painkillers, and either misuse those medications or turn to stronger and more dangerous drugs, like heroin. The U.S. has imposed stricter prescribing rules on doctors. Safe dosage limits are lower than they used to be, and doctors are instructed to only use opioids if the benefits outweigh the risks.

The Centers for Disease Control released an updated Guideline for Prescribing Opioids for Chronic Pain, which includes the following instructions for doctors:

  • Opioids are not meant to be first-line or routine therapy for chronic pain
  • Doctors should establish and measure goals for pain and function
  • Doctors should discuss benefits and risks and availability of nonopioid therapies with patient
  • Immediate-release opioids should be used when starting
  • When starting, doctors should prescribe the lowest effective dosage
  • When opioids are needed for acute pain, doctors should prescribe no more than needed
  • Doctors should not prescribe extended-release or long-acting opioids for acute pain
  • Doctors should follow-up and re-evaluate the risk of harm and reduce dose or taper and discontinue if needed
  • Doctors should evaluate risk factors for opioid-related harm, including addiction
  • Doctors should check state prescription drug monitoring program data to see if the patient has prescriptions from other providers
  • Drug testing should be conducted before prescribing opioids, to check for both prescription medications and illegal drugs
  • Doctors should avoid prescribing opioid pain medication and benzodiazepines at the same time
  • If a doctor determines that a patient does have a substance use disorder, he should offer to arrange for treatment, particularly medication-assisted treatment with buprenorphine or methadone in combination with behavioral therapies

In addition to limiting dosages, screening for which patients are good candidates for opioids, and avoiding extended release medications, another possibility is limiting the number of pills that are in a single prescription. In August 2017, the Utah-based Intermountain Healthcare, which operates 22 hospitals and 180 clinics, announced plans to reduce the average number of opioids in prescriptions for acute pain by 40 percent – an estimated 5 million pills annually – by the end of 2018. According to the CDC, sales of prescription opioids in the U.S. nearly quadrupled from 1999 to 2014, but there was no overall change in the amount of pain Americans report. When opioids are prescribed for acute pain – typically an injury or minor surgery that requires at most three or four days of pain relief – patients frequently have medication left over. Having these pills sitting around the house increases the chances that the patient, other members of the household, or visitors will take them improperly. The hope is that by prescribing a specific number based on the patient’s need, this potential for abuse will be decreased.

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