Prescription painkillers, such as Oxycodone and Tramadol, can be practically lifesaving medications for those who live with debilitating chronic pain. However, misuse or abuse of those medications can lead to serious drug addiction, and to thousands of deaths. The statistics are staggering: In the United States, 14,000 deaths were tied to prescription opiate overdose in 2014 alone.
Faced with a growing prescription drug problem that now affects every city and town in America, many lawmakers and federal agencies are advocating for tighter controls on opiate prescriptions in the hope of saving lives. Some governments have even taken to filing lawsuits against opioid manufacturers in the hope of recovering funds spent on this public health issue.
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Fighting the Opiate Abuse Epidemic
Restrictions on narcotic pain medications already exist through the federal Controlled Substances Act, which classifies the majority of opiate pain medications as “Schedule II” drugs. Drugs falling into that category are extremely tightly regulated: very few pills may be prescribed by a physician at one time, and patients cannot refill their prescriptions with the pharmacy without obtaining a new original prescription from their physician. These regulations were put in place to attempt to restrict the amount of these drugs in circulation. In 2014, the U.S. Drug Enforcement Agency moved even more opiate-containing pain medications to the restricted schedule, hoping to curb their abuse. Drugs that are a combination of anti-inflammatory drugs and opiates, such as Vicodin, are now grouped together with morphine and cocaine in the higher addiction risk category.
Unfortunately, prescription controls don’t seem to be having the intended impact on the opioid addiction crisis. Opiate abuse is still a serious social, medical, and legal problem. Meanwhile, patients with legitimate medical needs must overcome the considerable hurdles that these regulations place between them and their medications. America’s veterans are hit especially hard by the tighter regulations, as many soldiers badly injured in Iraq and Afghanistan suffer chronic debilitating pain. As many as half a million veterans are currently taking opiate medications for pain, according to the U.S. Veteran’s Administration (VA), which is the main source of health care for the majority of America’s current and former military personnel.
Unfortunately, veterans also experience higher-than-average rates of drug addiction and opiate overdose, leading many to question whether there are better treatment options for their pain.
While individual physicians still ultimately decide what they think are “legitimate” opiate prescriptions, the Centers for Disease Control (CDC) would like to see fewer opiates prescribed overall. They have released a set of guidelines for physicians to follow when considering prescribing them to patients for pain. Acute pain, for example, should only require a few days of narcotic pain pills, if over-the-counter medications aren’t strong enough – a week or more of opiates in these cases may create too high a risk of addiction. It’s a question of balancing risk and benefit, but these CDC guidelines are just guidelines, not law. Is anyone following them?
Requiring Ongoing Training for Doctors
Some lawmakers want to make absolutely sure doctors are hearing the message. In order to make opiates safer while keeping them accessible to individuals with chronic pain, they are proposing legislation that would mandate specific and comprehensive training for all physicians on the topic of safe and correct prescribing of opiate medications. According to The U.S. Food and Drug Administration (FDA), safety training on these topics is currently optional. Training on the risks and benefits of opiate medications is not required before prescribing them, and only half of the physicians who are invited to such trainings even bother to attend. The educational programs are also often funded by the drug companies that make the medications in question, raising the question of possible bias.
Senator Rob Portman (R-Ohio), cognizant of the toll that opiate addiction takes on the communities that he represents, authored the Comprehensive Addiction & Recovery Act (CARA), which allocates federal resources for drug treatment and recovery programs and for physician drug education. The act passed in near-unanimous votes in both the Senate and House of Representatives this spring: This is clearly an important bipartisan issue.
What would a required opiate training class look like? That’s not quite clear. The wording of the bill states that the Secretary of Health and Human Services “shall develop recommendations regarding education programs for prescribers of opioids,” which include current best practices within the confines of the law. The bill also calls for educating physicians and other health professionals on the use of naloxone, an opiate-reversing drug that can save lives in the event of overdose.
Will this improve patient safety as the bill’s authors intend? It’s possible. Certainly, educating medical professionals on the use of overdose-reversing medications is likely to save lives. And if physicians are better educated about addiction and best practices in pain management, it’s possible that fewer patients will be prescribed opiates in the first place, which might halt some addictions before they begin. But every restriction placed on opiate medications in the name of controlling the addiction problem is also a restriction on those who need the medications to get through every day, and that raises the question about which “best practices” are actually best.
Obviously, there’s a careful balance that must be reached between medicating those who need it, and avoiding addiction in those who are at risk, and even the experts find consensus difficult. In the end, the answer may lie in CARA and other legislation that seeks to educate physicians about addiction and to make addiction treatment more accessible. Addiction isn’t a problem that can be completely erased, but a little knowledge can go a long way towards minimizing it while maintaining a standard of care for the chronically ill.