Doctors Call for Pullback on Opioid Painkillers for Chronic Pain

Opioid painkillers like Vicodin, Percocet and OxyContin currently top the list of the most prescribed drugs in the United States. Are that many Americans in need of such strong pain management? Are American expectations about pain control unreasonable? Do pharmaceutical companies bear any responsibility for the current prescription drug crisis? Are these drugs safe to take long-term? The questions surrounding the rise in opioid addiction abound.

Three physicians in California are speaking out to their peers, asking them to halt the tide of prescription drug addiction and overdose. Their solution? Stop writing so many prescriptions. The doctors voiced their concern in an editorial published in the Archives of Internal Medicine.

The doctors lay out their case with statistics and ardor. They say that 20 percent of all doctor visits end up with the patient receiving a prescription for opioids. Furthermore, they say that 20 to 40 percent of U.S. adults report chronic pain unrelated to cancer. By far the most common treatment for those pain complaints is opioid drugs.

The trio says that not enough research has been done to look into the effects of long-term opioid use but plenty of evidence is available relative to the harm the drugs can do. One glaring example is the number of opioid-related deaths. More Americans die from opioid overdose than from heroin and cocaine combined – around 12,000 deaths per year.

The California physicians agree that most doctors prescribe opioids in an effort to improve a patient’s quality of life. They disagree as to whether opioids are the best tool for managing long-term pain. They suggest that opioids should be reserved for short-term pain control.

Chronic non-cancer pain management would be better served with education and non-pharmaceutical options, they say. The doctors suggest that many patients need to be brought to an understanding that pain management rather than pain elimination is the appropriate long-term goal. For many patients, they would prefer to prescribe exercise and physical therapy.

The American Pain Society disagrees on a number of points and has commented publicly on the physicians’ editorial. Doctors associated with the Society are not ready to throw opioids under the bus. One physician, speaking on behalf of the Society, made it plain that doctors ought to be evaluating a patient’s risk of addiction prior to prescribing opioids and then have a further responsibility to monitor patients who warrant the drugs.

Nonetheless, an American Pain Society doctor said that, in fact, there have been longer term observational studies and clinical trials and all evidence thus far says that opioids are effective in the treatment of pain for some patients. Low-risk elderly women with severe arthritis were given as an example of the type of patient who safely benefits from opioid treatment.

Prescription painkillers are being abused at a rate that calls for national attention. Stories have been splashed across the front pages of newspapers and news magazines, and articles encouraging restraint have appeared in many professional health care journals. Whether or not opioids deserve the broad brush elimination suggested by these California physicians is yet to be determined.