Doctor: Do no harm with your prescription pad

FILE - In this Oct. 16, 2014 file photo, Centers for Disease Control and Prevention (CDC) Director Dr. Tom Frieden, listens as he testifies on Capitol Hill in Washington. A bold federal effort to curb prescribing of painkillers may be faltering, amid stiff resistance from drugmakers, industry-funded groups and the government’s own top drug regulator. The agency has abandoned the January 2016 target date and opened the recommendations to public comment for 30 days. (AP Photo/J. Scott Applewhite)

Centers for Disease Control and Prevention (CDC) Director Dr. Tom Frieden. (AP Photo/J. Scott Applewhite)

The Director of the Centers for Disease Control this morning joined a growing list of high-ranking government officials pointing fingers at physicians who have prescribed enough opiate painkillers for every American to have their own stash.

Speaking at the National RX Drug Abuse and Heroin Summit in Atlanta, CDC  Director Dr. Tom Frieden said that although drug cartels have improved management of their supply chains and flooded the country with cheaper and more potent heroin, 75 percent of new heroin addicts say they started with prescription drugs.

“What we’ve said to doctors is remember that any single one of those prescriptions could ruin or end a patient’s life,” Frieden told an audience of hundreds of substance abuse stakeholders at the morning’s keynote session. “Prescription drugs are now gateway drugs.”

Although stopping short of blaming doctors and dentists who prescribe addictive painkillers, Frieden said reducing the supply with better prescribing practices coupled with law enforcement efforts would have a significant impact on the supply of drugs available.

“We  know of no other med routinely used that kills patients so frequently and it’s dose related,” Frieden said.”I’m sorry but at the CDC we don’t sugar coat it.”

A survey released by the National Safety Council on Tuesday found 99% of doctors are prescribing opioid medicines for longer than the three-day period recommended by the CDC. Twenty-three percent said they prescribe at least a month’s worth of opioids. Evidence shows that 30-day use causes brain changes, according to the survey.

Additionally, 74 percent of doctors incorrectly believe morphine and oxycodone, both opioids, are the most effective ways to treat pain. Research shows over-the-counter pain relievers such as ibuprofen and acetaminophen offer the most effective relief for acute pain, according to the survey.

Frieden’s comments came a week after the CDC released new guidelines for prescribing opioid for chronic pain. If adopted by doctors and dentists, patients with chronic and short-term can expect to see changes in the types and amounts of drugs prescribed.

Among the 12 recommendations:

  • Opioids are not first-line therapy. Acetaminophen, iburofen, exercise, weight loss and medications used to treat depression are alternatives that should be considered before opioids.
  • If opioids are necessary to treat acute pain, use immediate-release drugs – which relieve pain for shorter periods – should be prescribed at the lowest effective dose.  Three days should be sufficient. More than 7 days will rarely be needed.
  • Use urine drug testing before prescribing opioids for chronic pain and throughout treatment.
  • Discuss the risks and realistic benefits of opioid painkillers and consider discontinuing use if the benefits do not outweigh the risks.

Dr. Frieden’s comments echoed those of other speakers, including Surgeon General Dr. Vivek Murthy, who is drafting a letter about opioid prescribing to send to 1.3 million physicians, dentists and other health professionals who prescribe opioids.

President Obama also laid some of the blame on opioid prescribers, saying he was “shocked” at how little training medical students receive about treating pain and prescribing opioids. The sixty medical schools have agreed to add programs about treating pain and addiction and he encouraged physicians to participate in voluntary training programs.

“There is controversy over making this training mandatory — about over-regulation,” the president said. “If in fact training is not sufficient, we may have to look at the possibility of mandatory training.”

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