APS supports CDC's call for multifaceted approach to address prescription drug misuse

American Pain SocietyNov 10 2011

As reported by the U.S Centers for Disease Control, some 15,000 deaths occurred in the U.S. in 2008 from overdoses of prescription pain medications, and demand for treatment of prescription opioid addiction increased almost six fold between 1999 and 2009. The American Pain Society today expressed strong support for CDC's call for a multifaceted approach to address the problem and for its assertion that efforts to rectify this public health crisis must strike a balance between reducing misuse and abuse while safeguarding legitimate access to treatment.

"Properly prescribed and used opioid medications can restore function and quality of life to patients suffering with pain", said APS President Seddon R. Savage MD. "Misused, however, they can lead to injury, death or a devastating cycle of addiction. As the CDC report shows, misuse of opioid drugs is alarmingly high in the United States. Physicians clearly have an obligation to their patients and society to prescribe opioids in a responsible manner that limits the potential for harm."

In 2009, APS in collaboration with the American Academy of Pain Medicine published comprehensive evidence- based clinical practice guidelines, which are referenced in the CDC report, to assist clinicians in prescribing opioid pain medications for patients with chronic non-cancer pain. Published in The Journal of Pain, the guidelines state that prescribers of opioid pain drugs should have clinical skills and knowledge in both the principles of opioid treatment and the assessment and management of risks associated with drug abuse, addiction and diversion.

According the APS-AAPM guidelines, before prescribing an opioid medication, the physician must conduct a thorough medical history and examination and assess potential risk for substance abuse, misuse or addiction. The strongest predictor of possible drug misuse is a personal history of alcohol and drug abuse. For patients at higher risk for drug misuse, doctors must provide more highly structured care that may include more frequent visits, regular urine drug screens, regular contact with family members, smaller prescriptions, pill counts, counseling, or other interventions.

"Regular monitoring of chronic opioid therapy patients is critical because the therapeutic benefits of these medications are not static and can be affected by changes in the underlying pain condition, coexisting disease, or changing psychological or social circumstances," said Dr. Savage. "Weekly monitoring is justifiable for some patients at high risk for misuse and other adverse events."

Since household diversion of legitimately prescribed opioid medications is a leading cause of drug misuse, pain patients should be encourage to lock their medications and discard no longer needed medications to prevent diversion.

Although strong evidence is lacking on the best methods to reduce prescription drug misuse, Dr. Savage noted that emerging evidence suggests potential risks can reduced by more frequent and intense monitoring of patients identified at higher risk. In some patients, however, the risks outweigh potential benefits and efforts must be redoubled to provide effective non-opioid therapies or the patient referred to receive opioid in an addiction treatment setting such as a methadone maintenance or buprenorphine treatment.