The Centers for Disease Control and Prevention this week released well-reasoned guidelines for how doctors should prescribe opioid painkillers. The voluntary standards could make a difference in curbing the alarming increase in prescription drug deaths.
In 2014, overdoses of opioids, like oxycodone and hydrocodone, and related drugs like heroin were responsible for 28,647 deaths, up 14 percent from the year before. About one in 550 people who received opioids for chronic pain not linked to cancer died from an opioid-related overdose a median of 2.6 years after their first prescription. “We know of no other medication routinely used for a nonfatal condition that kills patients so frequently,” Dr. Thomas Frieden and Dr. Debra Houry of the C.D.C. wrote in The New England Journal of Medicine on Tuesday.
To reduce this high toll, the C.D.C. is advising doctors not to prescribe opioids for chronic pain in most situations. Studies have found no evidence that the long-term use of opioids is beneficial, and in fact, exercise, physical therapy and over-the-counter drugs like acetaminophen can be more effective. The guidelines do not apply to cancer treatment, palliative care and end-of-life care, situations in which opioids are often the only way to reduce pain.
The guidelines also advise doctors prescribing opioids to start with low doses, prescribed for three days or less and rarely for more than seven days. Doctors should also clearly warn patients that the drugs are highly addictive and check prescription-monitoring programs to see if people are getting drugs from multiple physicians. Most states have such programs, but many do not require that doctors use them.
Though the guidelines are voluntary, they carry a lot of weight with doctors, hospitals, insurers and health regulators. The C.D.C.’s analysis is likely to influence how state governments develop laws and regulations for opioid prescriptions. Last month, the National Governors Association said it would create prescription protocols by July. Some states are already far along in this process. Gov. Charlie Baker of Massachusetts signed a law on Monday that forbids doctors from writing opioid prescriptions for more than a seven-day supply. Lawmakers in Vermont and Maine are considering similar laws.
There is more that could be done. Now that the C.D.C. says these drugs should not be used to treat chronic pain, the Food and Drug Administration should forbid the makers of opioids from marketing them to doctors for those purposes. There also needs to be more access to treatment for opioid addicts. The Senate recently passed a bill that authorizes treatment programs, but that legislation did not include adequate funding. President Obama has proposed spending $1.1 billion on opioid abuse programs, with $920 million going to help states provide medication-assisted treatment, a plan Congress should support.
For far too long, the medical profession and policy makers ignored growing evidence that prescription painkillers were causing great harm. Now that abuse has become an epidemic, the government needs to mount a much stronger response to it.