WASHINGTON — Prescription painkillers should not be a first choice for treating common ailments such as back pain and arthritis, according to new federal guidelines designed to reshape how doctors prescribe drugs such as OxyContin and Vicodin.
Amid an epidemic of addiction and abuse tied to these powerful opioids drugs, the Centers for Disease Control and Prevention is urging primary care doctors to try physical therapy, exercise and over-the-counter pain medications before turning to painkillers for chronic pain. Opioid drugs include medications such as morphine and oxycodone as well as illegal narcotics such as heroin.
The new recommendations — which doctors do not have to follow — represent an effort to reverse nearly two decades of rising painkiller use, which public health officials blame for a more than four-fold increase in overdose deaths tied to the drugs. In 2014, U.S. doctors wrote nearly 200 million prescriptions for opioid painkillers, while deaths linked to the drugs climbed to roughly 19,000 — the highest number on record.
“We’re trying to chart a safer and more effective course for dealing with chronic pain,” Dr. Tom Frieden, the CDC’s director, said in an interview with The Associated Press.
More than 40 Americans die every day from painkiller overdoses, a staggering rate that Frieden said is “doctor driven.”
Under the new guidelines, doctors would prescribe painkillers only after considering non-addictive pain relievers, behavioral changes and other options. The CDC also wants doctors to prescribe the lowest effective dose possible. And doctors should only continue prescribing the drugs if patients show significant improvement.
For short-term pain, the CDC recommends limiting opioids to three days of treatment, when possible.
The guidelines do not apply to doctors who specialize in treating severe pain due to cancer and other debilitating diseases.
Though the guidelines are voluntary, they could be widely adopted by hospitals, insurers and state and federal health systems.
Government officials have already tried multiple approaches to tackling painkiller abuse. The Food and Drug Administration restricted some painkillers to limit refills. Florida and New York have cracked down on “pill mills” using databases to monitor what doctors are prescribing. And this week, Massachusetts signed into law a seven-day limit on first-time prescriptions for opioids.
“Changing medical practice isn’t quick and it isn’t easy,” Frieden said. “But we think the pendulum on pain management swung way too far toward the ready use of opioids.”
The CDC rarely advises physicians on how to prescribe medications.
FDA labeling for the drugs is broad, listing uses like “relief of moderate to severe pain.” Guidelines by pain specialists provide more detail, but focus less on risks. The CDC guidelines put such warnings upfront: “Opioids are not first-line therapy,” states the agency’s first recommendation.
