In March of 2016, the CDC released the Guidelines for Prescribing Opioids for Chronic Pain. The summary of evidence demonstrates that the risk of opiate use greatly outweighs the benefit for the majority of patients. Population studies of death rates and prescribing practices demonstrate a close relationship between the amount of opiates prescribed and deaths related to their use. In short, there is inadequate evidence to support long-term opiate use for chronic, non-cancer pain
Improving the way opioids are prescribed through clinical practice guidelines can ensure patients have access to safer, more effective chronic pain treatment while reducing the number of people who misuse, abuse, or overdose from these drugs.
The likelihood of chronic opioid use increases with each additional day of medication supplied starting with the third day, with the sharpest increases in chronic opioid use observed after the fifth and thirty-first day on therapy, a second prescription or refill, 700 morphine milligram equivalents cumulative dose, and an initial 10- or 30-day supply.
Since 1999, opioid prescriptions have quadrupled, and over 183,000 people have died from prescription opioids.
In Oregon in 2013, drug poisoning deaths involved prescription opioids more than any other type of drug, including methamphetamines, heroin, cocaine, and alcohol.* The United States is in the midst of an opioid overdose epidemic. Opioids (including prescription opioids and heroin) killed more than 33,000 people in 2015, more than any year on record. Nearly half of all opioid overdose deaths involve a prescription opioid.
THA realizes that treating chronic opioid patients for non-cancer pain of the back and spine can be difficult and that the intent of the guidelines can and will be difficult to apply in certain cases. By using these guidelines as a standard for reducing and eventually stopping opioid use for chronic non-cancer pain of the back and spine, the patient will not be dependent on a drug that is harmful to themselves and indirectly to others.
If a Provider believes the patient has developed a dependence and/or addiction to opioids and cannot be tapered off before or by January 1, 2018, the patient should be evaluated for a substance abuse disorder which is covered on Line 4 of the prioritized list. Please contact the Washington County Mental Health Member Service at 503-291-1155 for information on substance abuse referrals.
* http://www.samhsa.gov/data/sites/default/files/NSDUHStateEst2012-2013- p1/ChangeTabs/NSDUHsaeShortTermCHG2013.htm