Addressing a growing “epidemic” of opioid overdoses and abuse of the prescribed painkillers in the United States, the Centers for Disease Control and Prevention released voluntary guidelines Tuesday that instruct primary care doctors to sharply deter use of the medicines for chronic pain.
“Overprescribing opioids, largely for chronic pain, is a key driver of America’s drug-overdose epidemic,” CDC Director Tom Frieden said. Sales of the prescription therapies have quadrupled since 1999, causing 165,000 fatal overdoses over the same period and growing at more than 40 per day, according to the agency.
U.S. health officials, in a media conference call, said first responders should have wider access to Naloxone, a drug that can reverse the effects of opioid overdoses.
Primary care doctors who treat adults for chronic pain in outpatient settings account for nearly half of all opioid prescriptions, the CDC said. It defined chronic pain as lasting longer than three months, or past the typical time it takes for normal tissue healing.
The new guidelines recommend non-opioids, such as acetaminophen and ibuprofen, as preferred therapy for chronic pain unless patients have active cancer or are receiving palliative or end-of-life care.
When opioids are used, the lowest possible dose should be prescribed to reduce risks of opioid abuse and overdose and patients should then be closely monitored, according to the CDC guidelines. The drugs should also be combined with non-drug approaches to controlling pain, such as physical therapy and exercise, the agency said.
Moreover, when starting opioid therapy for chronic pain, doctors should prescribe immediate-release formulations instead of extended-release/long-acting versions, the guidelines say. They recommend doctors avoid prescribing opioids with sedatives called benzodiazepines, which include anti-anxiety treatments Xanax (alprazolam), Ativan (lorazepam) and Valium (diazepam).
When prescribed for acute or short-term pain, doctors should prescribe the lowest effective dose of immediate release opioids.
“Three days or less will often be sufficient; more than seven days will rarely be needed,” the guidelines say.
The most widely used opioids include hydrocodone, which is the main active ingredient of Vicodin, and oxycodone, an active ingredient of OxyContin and Percocet. They are synthetic narcotics that work by binding to opioid receptors in the brain and are mostly available in pill form, though some opioids are available in skin patches.
Nearly 2 million Americans aged 12 or older either abused or were dependent on prescription opioids in 2014, the CDC said.
Opioids also include heroin, an illegal injectable drug, which has become a far cheaper alternative to oral opioids on the streets of many U.S. communities, causing many overdoses.