Prescription Drug Guidelines, Monitoring Programs a Must in Treating Chronic Pain

Opioids are ineffective in the treatment of chronic pain, and the dangerous risks associated with using and abusing opioids have led to America's most deadly drug epidemic.

Nearly 19,000 people each year fatally overdose on opioids, a surge that has caused poisonings to overtake motor vehicle crashes as the #1 cause of unintentional death among adults in the United States.

In a joint effort to find solutions to a problem that has been growing for decades, the National Safety Council and other like-minded safety organizations are calling for broader and more consistent use of state Prescription Drug Monitoring Programs. NSC and the Centers for Disease Control and Prevention also support publishing clear guidelines for prescribing opioid painkillers.

Initiating Therapy

Before anyone begins long-term opioid therapy, careful consideration must be given to evidence-based opioid prescribing. Doctors should provide:

• Appropriate informed consent, including a clear description of the risk of falls, cognitive impairment, driving impairment, constipation, hyperalgesia, physical dependence, addiction and premature death
• Thorough screening for mental illness and/or substance use disorders
• Detailed history, including family history, and a search of the state prescription monitoring program
• Evaluation of current functional abilities
• Complete physical evaluation and drug screening

How Much is Too Much?

When it comes to prescribing opioids, there is no such thing as a safe maximum dose. Doses greater than 20 morphine milligram equivalents per day increase the risk of overdosing. Doses greater than 100 MME increase the risk even more.

In fact, those on a dose of 100 MME or greater are nine times more likely to overdose than their low-dose counterparts. This MME calculator is a useful tool for patients on long-term opioid therapy.

Connecting the Dots

Although many long have believed opioids are the strongest pain medications and should be used for more severe pain, scientific literature does not support that belief. NSC medical advisors say alternative medications and non-pharmacologic treatments should be used for treating pain.

Studies have shown non-steroidal anti-inflammatory drugs (such as ibuprofen and naproxen) are just as effective as opioids.

People who experience chronic pain and are treated with opioids are at higher risk of abuse and dependence, according to a report issued by the Clinical Journal of Pain. Not surprisingly, the CDC reports overdose rates are higher in states where prescription painkillers are prescribed more frequently.