The Centers for Disease Control and Prevention on Tuesday released final guidelines warning doctors to be more cautious about prescribing opioids to adults as concern grows over the abuse of painkillers.
The agency is recommending that non-opioid drugs be prescribed whenever possible and that when patients get opioids, low doses and less than a week’s supply should be provided.
The guidelines are not binding, and doctors cannot be punished for failing to follow them. But the CDC is trying to bring about “a culture shift for patients and doctors,” according to CDC director Tom Frieden.
“We are waking up as a society to the fact that these are dangerous drugs,” he said in an interview. “Starting a patient on opiates is a momentous decision, and it should only be done if the patient and the doctor have a full understanding of the substantial risks involved.”
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The recommendations are being released as Congress grapples with legislation aimed at helping medical providers and local governments combat heroin and painkiller abuse through better public education, addiction treatment, programs to encourage the disposal of excess drugs and the wider use of overdose antidotes such as Naloxone.
Frieden said many doctors also need a refresher course on how to prescribe pain medications.
“When I went to medical school I had exactly one lecture on pain, and the lecture said if you give an opioid to a patient in pain, they will not get addicted,” Frieden said. “Completely wrong, and yet a generation of doctors grew up being taught that.”
Years ago, doctors often were criticized for undertreating pain, Frieden said. But in 2013, health care providers wrote 249 million prescriptions for opioid pain relievers, according to the CDC’s findings.
Now, patients are demanding to be treated with opioids, Frieden said, and doctors who are worried about being downgraded in patient satisfaction ratings are giving them those drugs.
CDC officials stressed that in many cases, opioid drugs do not lessen pain as well as other therapies, such as anti-inflammatory drugs or, in some cases, exercise. The agency also is encouraging patients to start questioning their doctors if they prescribe opioids for chronic pain.
Opioids “carry substantial risks but only uncertain benefits,” Frieden said. “The risks will outweigh the benefits for the vast majority of patients.”
Only about 5 percent of patients being prescribed opioid painkillers are receiving them for chronic pain instead of conditions such as cancer therapy, surgery or end-of-life care. The CDC’s recommendations do not apply to categories of patients needing opioid drugs for acute pain mitigation.
But that 5 percent of patients accounts for about 70 percent of opioid prescriptions, officials said, and more than 70 percent of patients dying of opioid-related overdoses became addicted while being treated for chronic pain.