Pain Management

Federal Agencies, States Move Swiftly to Combat Opioid Overdose Epidemic

June 20, 2016
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In response to overwhelming increases in national opioid use that have resulted in an epidemic of opiate overdoses, the CDC has published drastically new chronic pain management guidelines that strongly discourage opiate use as a first-choice therapy for the treatment of chronic pain.

If opioid treatment is needed, it should be administered in conjunction with nonpharmacological, non-opioid therapy and doses should ideally not exceed a 50 morphine milligram equivalent (MME) per day threshold. Should higher doses prove unavoidable, physicians and prescribers must strongly consider the potential risks of overdose, particularly at doses of 90 MME/day or greater. Patients starting out on opioids should be administered immediate release methods at the lowest dosage that still proves effective, and their healthcare professionals should regularly reevaluate their benefit/risk situation at least every three months. Cross-referencing in state-run prescription databases allows physicians to ensure patients are not getting opioids from other sources as well as keep patients from receiving dangerous combinations of prescriptions. In cases of acute pain, three to four days of therapy will typically suffice, while requiring over a week of therapy is exceedingly rare. Patients with a history of opioid abuse or with opioid use disorder should undergo treatments like buprenorphine. For patients at especially high risk of overdose, physicians should consider the prescription and use of naloxone.

In addition to the CDC, the White House has unveiled a campaign to fight opiate abuse. The plan entails doubling patient limits for clinicians allowed to prescribe buprenorphine to 200, expanding training for those who provide buprenorphine, and increasing funding for substance use disorder treatment facilities, particularly in the hardest hit, yet heretofore least addressed, populations.

At the state level, a few state legislatures have taken steps to lower opioid prescription amounts; in Massachusetts, for instance, a bill was recently passed that limits opioid supply post-surgery to seven-days — an approach other states in the New England region are considering as well.