Newspaper article International New York Times

U.S. Issues Guidelines to Curtail Use of Painkillers ; First Opioid Standards Come in Response to Soaring Addiction Rates

Newspaper article International New York Times

U.S. Issues Guidelines to Curtail Use of Painkillers ; First Opioid Standards Come in Response to Soaring Addiction Rates

Article excerpt

The nonbinding standards by the federal Centers for Disease Control and Prevention come after arguments with pain doctors and drug industry groups.

In an effort to curb the worst public health crisis involving drugs in decades, the federal government on Tuesday published the first national standards for prescription painkillers in the United States, ending months of arguments with pain doctors and drug industry groups and beginning what officials contended would be more judicious prescribing of the highly addictive medicines.

The guidelines, issued by the Centers for Disease Control and Prevention, are nonbinding, and they come after numerous professional medical societies as well as some states have issued restrictions of their own. But they are the broadest measure now in place addressing the medications known as opioids, and they are likely to have sweeping effects on the practice of medicine.

"This is the first time the federal government is communicating clearly to the medical community that the risks outweigh the potential benefits of these drugs," said Dr. Andrew Kolodny, head of Physicians for Responsible Opioid Prescribing, which supports the guidelines. "It's one of the most significant interventions by the federal government."

Dr. Thomas R. Frieden, director of the disease centers, said, "It's become increasingly clear that opioids carry substantial risk but only uncertain benefits -- especially compared with other treatments for chronic pain."

The guidelines recommend what many addiction experts have long called for -- that doctors first try ibuprofen and aspirin to treat pain, and that opioid treatment for short-term pain last for three days, and rarely longer than seven. That is far less than current practice, in which patients are often given two weeks or a month worth of pills.

The guidelines are meant for primary care doctors, who prescribe about half of all opioids but often have little training in how to use them. They call for patients to be urine tested before getting prescriptions and for doctors to check prescription drug tracking systems to make sure patients are not secretly getting medicine somewhere else. Currently, 49 states have such systems, but only 16 require that doctors use them, according to experts at Brandeis University.

The guidelines do not apply to prescriptions for patients who are receiving cancer or end-of-life treatment.

In the works for nearly two years, the standards have been bitterly opposed by the drug industry and pain doctors, who argue that rules would pose unfair hurdles for legitimate patients who have long-term pain. …

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