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When the Prescription Becomes the Problem

May 08, 2015  |  Falmouth Enterprise

Dr. Michael Bihari

Last month, the Centers for Disease Control and Prevention (CDC) launched a public social media campaign, When the Prescription Becomes the Problem, to raise awareness about prescription drug addiction and overdose. According to the CDC website the campaign is to “tell the stories of the many people whose lives have been affected by prescription painkiller addiction or the death of a loved one. Encourage those in need to seek treatment for addiction. Celebrate others who are already working to change lives, and inspire our communities to improve patient safety and the way we treat pain.”

People who participate in the program are being asked to write a six-word story or message and create an original picture or a video tagged #RxProblem to post on Facebook, Instagram and Twitter. The CDC provides suggested graphics and sample messages.

The CDC website also contains additional information about pain management and the epidemic of opioid misuse and overdose, including:

The Supply of Prescription Opioid Painkillers Remains High

In 2012, health care providers wrote 259 million prescriptions for painkillers, enough for every American adult to have a bottle of pills. Changes in how providers prescribe prescription painkillers have helped fuel the opioid  epidemic. While prescription opioids play an important role in managing some types of pain, some healthcare providers are overprescribing these drugs, particularly for chronic, non-cancer pain. There is little evidence that long-term opioid treatment improves chronic pain, function, and quality of life. Moreover, long-term use of opioid painkillers for chronic pain can be associated with abuse and overdose, particularly in higher doses.

According to the CDC, “Most people who abuse prescription opioids get them for free from a friend or relative. However, those who are at highest risk of overdose (using prescription opioids nonmedically 200 or more days a year) get them in ways that are different from those who use them less frequently. These people get opioids using their own prescriptions (27 percent), from friends or relatives for free (26 percent), buying from friends or relatives (23 percent), or buying from a drug dealer (15 percent). Those at highest risk of overdose are about four times more likely than the average user to buy the drugs from a dealer or other stranger.”

Risk Factors for Prescription Painkiller Abuse and Overdose

Research shows that some risk factors make people particularly vulnerable to prescription painkiller abuse and overdose, including:

  • Obtaining overlapping prescriptions from multiple providers and pharmacies
  • Taking high daily dosages of prescription painkillers.
  • Having mental illness or a history of alcohol or other substance abuse.
  • Living in rural areas and having low income.

Inappropriate provider prescribing practices and patient use are substantially higher among Medicaid patients than among privately insured patients. In one study based on 2010 data, 40% of Medicaid enrollees with painkiller prescriptions had at least one indicator of potentially inappropriate use or prescribing, such as:

  • overlapping painkiller prescriptions
  • overlapping painkiller and benzodiazepine prescriptions
  • long-acting or extended release prescription painkillers for acute pain
  • high daily doses of pain medication

What Health Care Providers Need to Know about the Opioid Epidemic

From 1999 to 2013, the amount of prescription opioids dispensed in the U.S. nearly quadrupled, yet there has not been an overall change in the amount of pain that Americans report. 

For safe and effective pain management, the CDC recommends that physicians provide their patients with safe, effective pain management and reduce their risk of misuse, abuse or overdose

Talk with your patients about: 

  • The risks of taking prescription opioids, including addiction, overdose and death.
  • A variety of pain treatment options that may be appropriate for their condition, such as over the counter pain relievers or physical therapy and exercise.

Follow best practices for responsible painkiller prescribing, including:

  • Prescribing the lowest effective dose and only the quantity needed for the expected duration of pain.
  • Planning with your patients on how to stop opioids when their treatment is done.
  • Providing your patients with information on how to use, store, and dispose of opioids.
  • Avoiding combinations of prescription opioids and sedatives unless there is a specific medical indication.
  • If available, use your state’s prescription drug monitoring program to identify patients who might be misusing prescription drugs and are at risk of overdose. (note: such a program is available in Massachusetts)

Responsible prescribing can save lives!

How to Manage Your Pain

The CDC also has advice for patients about how to manage their pain safely and effectively. You can talk to your health care provider about ways to manage your pain that do not involve prescription painkillers. Options include:

  • Acetaminophen (Tylenol) or non-steroidal anti-inflammatory medications like ibuprofen (Advil)
  • Certain antidepressants and anticonvulsants for neuropathic pain
  • Physical therapy and exercise
  • Cognitive behavioral therapy

If your pain management plan includes prescription painkillers, you can

  • Have a conversation with your health care provider about the risks of taking these powerful medicines,
  • Make a plan with your health care provider on when and how to stop, and
  • Be sure to use them only as instructed by your health care provider.

And, when it comes to using a narcotic painkiller safely, you may want to consider the following ground rules:

  • Never take a narcotic pain medication that is not prescribed to you
  • Never adjust your own doses
  • Never mix with alcohol
  • Taking sleep aids or anti-anxiety medications together with narcotic pain medication can be dangerous
  • Always tell your physician about all medications you are taking from any source, including over-the-counter
  • Keep track of when you take your medications
  • Keep your medications locked in a safe place
  • Dispose of any unused medications at your local police station drug kiosk

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