Pressure to limit opioid prescriptions gains steam

February 22, 2018 06:45 PM


Health insurers are joining in the fight against opioid abuse. Many adopted new prescribing guidelines this year. The changes affect both new prescriptions for immediate need and those for chronic treatment.


These changes are encouraged by the Centers for Disease Control. They include a seven-day limit for acute or immediate use and limiting the maximum dose of opioids per patient per day.

Pain management experts applaud these moves, but say it's just a start.

Dr. Edward Apicella is a pain management expert. He's very clear about limiting the use of narcotics to relieve pain.
"Thirty days should not be prescribed for acute pain or for post-op pain," he advised.
Seven days max says Dr. Apicella, because for some people, 30 days is all it takes to get hooked.
Opioids act on a specific receptor in our brain.
"The receptors change and what you end up with is a narcotic or an opioid that is actually worsening the pain instead of getting it better," he noted.
So before an opioid is prescribed for long-term use, Apicella says other options should be tried -- including non-narcotic analgesics, exercise, physical therapy, acupuncture, anti-depressants and anti-convulsant drugs, behavior modification interventions.
He says too often, doctors not schooled in pain management write opioid prescriptions inappropriately -- a big part of how we got into this opioid crisis.
In 1996, the Veteran's Administration, along with the Joint Commission on Accreditation of Healthcare Organization (JCAHO) and the American Pain Society introduced the phrase – "pain" as the "5th Vital Sign." The other vitals are blood pressure, heart and respiratory rates and temperature.
Doctors were encouraged to treat pain, but pain is a symptom that can't objectively be measured.
Apicella says the result of treating pain is skyrocketing opioid use.
Consider Kelsey Murphy's experience. When she was 17, she was given a legitimate prescription to treat severe strep throat. By 19, she was hooked on prescription painkillers. At 22, she entered her first rehab. Now 27, she's a mom and warning others about the drug spiral she never thought she'd get caught in.
"I think I was 21 when I started using heroin," she recalled.
Sadly, her story is not unique. That's why Dr. Apicella says when an opioid is prescribed, it should be at the lowest possible dose and only after the patient is carefully screened.
"You have to assess their behavioral issues if they have any -- depression, anxiety, borderline personality disorder," he cautioned.
He acknowledges some doctors still give in to patients who browbeat them into writing an opioid prescription. He's clear, that has to stop.
Yes, there's the issue of unintended consequences -- that as we tighten opioid prescriptions, those already addicted move onto street drugs like heroin.
"I think the first step is not creating the addict," he asserted.
That's something the medical profession must take to heart.
"No matter where you attack this, unless the education improves, the prescription writing is tightened down and the illicit drugs are limited, we are always going to have a problem," he warned.



WNYT Staff

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