1. Opinion

Editorial: Firm but flexible rules for painkillers

Published Mar. 18, 2016

The federal government issued largely sensible guidelines last week for prescribing pain medication that are designed to prevent opioid overdoses and abuse. There is clearly a need for a national standard to help doctors better manage drugs such as OxyContin, Percocet and Vicodin, the abuse of which helped fuel a nationwide pill mill epidemic that resulted in drug addictions and deaths. Physicians should consult the new rules, but they ultimately should consider each patient individually to avoid unfairly restricting access to pain medication for people truly in need of relief.

The Centers for Disease Control and Prevention announced new voluntary guidelines to aid clinicians as they seek to determine how to care for patients with chronic pain in outpatient settings. The guidelines do not apply to people receiving cancer treatment, palliative care or end-of-life care. The government's 12 recommendations are aimed at adults with pain that lasts more than three months or past the time of normal tissue healing.

In its guidelines, the CDC encourages doctors to consider non-opioid therapy such as aspirin, physical therapy or psychological therapy before prescribing opioids, which can be highly addictive and have adverse side effects. When opioids are used, the CDC recommends that doctors prescribe the lowest effective dosage to minimize the potential for overdose and addiction. In many cases, a three-day supply of pain medications will be sufficient, the CDC said. A prescription lasting longer than seven days should be rare. The government also wants doctors to make sure the benefits of the drug outweigh the risks and to closely monitor patients for signs of abuse and opportunities to taper off prescriptions.

The guidelines come in the wake of a nationwide epidemic of opioid addiction and overdose deaths. In 2012, health care providers wrote an astounding 259 million prescriptions for opioid pain medications, enough for every adult in the United States to have a bottle of pills, according to the CDC. From 1999 to 2014, more than 165,000 people died from an overdose related to opioid pain medication.

Once ground zero for pill mills, doctor shopping and opioid abuse, Florida knows firsthand what can happen when the painkiller industry goes unchecked. The state reined in rampant prescription opioid abuse through a targeted law enforcement effort and instituted policies that have made it harder to obtain painkillers. Unfortunately, people with a legitimate need for medication to control chronic pain have run into unnecessary roadblocks and report increasing difficulties accessing the drugs they need.

There shouldn't be a one-size-fits-all formula for patients who are experiencing chronic pain. Patients with long-term conditions who have not shown a tendency for abuse should be allowed to receive medications that help make their conditions manageable for the time necessary. The CDC recognized the potential quandary posed by its new rules, saying "different choices will be appropriate for different patients." As the medical community attempts to adopt a national standard, doctors should remember to treat each patient as an individual worthy of personalized care and write prescriptions accordingly.