New guidelines from the Centers for Disease Control and Prevention urge doctors to take it easy in prescribing the potentially killer drugs, making it clear that overprescribing is driving an epidemic of opioid addiction.
The guidelines encourage doctors to try something besides an opioid when first treating pain, even suggesting ice and talk therapy. And if an opioid drug such as oxycontin is the best choice, they need to start with the lowest possible dose.
The guidelines, published in the Journal of the American Medical Association, also suggest that patients question whether they need such strong drugs to control their chronic pain.
The short take on the CDC guidelines:
- Don't use opioids first. Try other methods such as Tylenol, ibuprofen or ice
- Talk to the patient about what they can expect. 100 percent pain-free may not be realistic or desirable
- Make sure the patient knows the risks
- Never start with the long-acting opiates and use the lowest possible dose
Opioid drugs, which are related to morphine and heroin, are dangerous, said CDC director Dr. Thomas Frieden.
"For the vast majority of patients, the risks will outweigh the benefits for chronic pain," Frieden told reporters in a conference call.
It's just advice, Frieden noted.
"We are not a regulatory agency so these are guidelines," he said. "CDC does not regulate the practice of medicine."
CDC says deaths from opioid overdoses have hit an all-time record in the U.S.
The drugs killed more than 47,000 people in 2014 -more than the 32,000 who died in road accidents. "It's one of the few trends in this country where health is getting worse," Frieden said.
The administration of President Barack Obama has made the overdose epidemic a political priority, and Congress recently held up the appointment of the new Food and Drug Administration commissioner, Dr. Robert Califf, until he promised reforms.
"In 2013 alone, an estimated 1.9 million persons abused or were dependent on prescription opioid pain medication," the CDC's Dr. Deborah Dowell and colleagues wrote in the published version of the recommendations.
Frieden said he was "stunned" to learn that one out of every 32 patients given the highest doses of opiate drugs would die within two and a half years.
And it's clear who's to blame. "The prescription overdose epidemic is doctor-driven," Frieden said.
But he said patients are responsible too, and they need to stop demanding the strongest painkillers and need to start talking to doctors about their expectations.
"The best treatment isn't always the one that provides the most immediate relief," Frieden said.
Unless doctors are treating people with cancer, who are dying or who have some other incurable but agonizing condition, they need to set an end point for the treatment, the guidelines say.
"Three days or less will often be sufficient. More than seven days will rarely be needed for most acute pain syndromes," Frieden said.
Dr. Thomas Lee of Harvard Medical School agreed.
"Compassion for patients does not mean the elimination of all pain," Lee wrote in a commentary in JAMA on the guidelines.
"There is, quite simply, no 'getting it right' when it comes to pain. It is both undertreated and overtreated."
And there is plenty of pain in the U.S., Dowell and colleagues said.
"The number of people experiencing chronic pain is substantial, with US prevalence estimated at 11.2 percent of the adult population," they wrote. They said 3 percent to 4 percent of the population prescribed long-term opioid therapy.
But other things work, too, to help chronic pain, they pointed out.
'For example, cognitive behavioral therapy (CBT) had small positive effects on disability and catastrophic thinking," the CDC team wrote.
"Exercise therapy reduced pain and improved function in chronic low back pain; improved function and reduced pain in osteoarthritis of the knee and hip," they added.
Acetaminophen, sold often as Tylenol, works best first for arthritis.
"The new prescribing guidelines approved by the CDC are an important step in addressing America's opioid crisis," said Gary Mendell, founder and CEO of Shatterproof, a national non-profit organization focused on ending addiction.