The Opioid Epidemic: Changing the Rules of the Pain Game
Author: William S. Jacobs, M.D
Too many young adults are dying from opioid overdoses. In an effort to curb the gateway source of the opioid addiction epidemic, the Centers for Disease Control and Prevention has issued strict guidelines restricting prescriptions for opioid painkillers from primary care doctors and dentists treating patients for pain.
Tragically, this may not stem the tide if doctors and dentists choose to ignore the guidelines and continue their current practices. It’s important for parents to know that the risk still exists and that access to these opioids is relatively easy – and that another cheap, illicit opioid called fentanyl has also claimed many lives.
Four-fold increase in opioid prescriptions and deaths
The opioid epidemic slowly took root over the last 20 years, as prescriptions for Vicodin and Percocet quadrupled. Deaths from these painkillers have also quadrupled, data show. These prescriptions come from primary care outpatient facilities or dentists’ office, prescribed for chronic pain after a sports injury or a tooth extraction.
When taken for a short time and under a doctor’s instructions, opioids can be very effective for alleviating pain and are generally safe. However, many people use the drugs long-term – three months or longer – despite many health care professionals claiming there is a lack of evidence to suggest that such treatment is effective. In fact, there is evidence that acetaminophen and ibuprofen work just as well, in combination.
Linked to heroin, morphine, fentanyl
The abuse of prescription painkillers has led to heroin and morphine addiction. Most recently, fentanyl has been added to the list. Fentanyl is an opioid painkiller that dates back to the 1960s. Fentanyl has been used in medical settings for severe pain, via lozenges or patches. Illicit fentanyl has now seeped into the United States from Mexico, easily available at cheap prices.
Fentanyl, which looks like heroin, is a powerful synthetic painkiller that has been laced with heroin but is also sold separately – at a cheap price – and often without the user’s knowledge. It is up to 50 times more powerful than heroin and up to 100 times more potent than morphine. A tiny bit can be fatal.
In some areas in New England, fentanyl kills more people than heroin. In New Hampshire, fentanyl alone killed 158 people last year; heroin killed 32.
Strict CDC guidelines
The CDC has set a strict definition for chronic pain as pain lasting longer than three months or past the normal healing period.
The 12 points in the CDC advisory urge doctors to adopt three principles:
- Promote non-opioid drugs for chronic pain.
- If opioids are used, prescribe the lowest possible dose to avoid misuse and overdose.
- Exercise caution when prescribing opioids, and monitor all patients closely.
Doctors should prescribe only the quantity necessary for the specific patient’s case. Three days or less is often sufficient. Rarely will a patient need meds longer than seven days. Evidence shows that a combination of over-the-counter pain relievers – ibuprofen and acetaminophen – may be more effective than opioid painkillers.
Parental responsibility is required
None of this takes the place of parental responsibility – keeping track of kids’ activities and friends. How do children spend their monthly allowance? Do they understand the risks of drugs? Is anyone monitoring pills prescribed to children?
A trusting parent-child relationship is essential in these discussions. If children sense sincere concern, they will be more likely to stay clean. Hopefully, these guidelines will stem the source of these drugs to protect more kids and adults from taking the first steps toward opioid addiction.