medicine
4:18 pm
Wed October 31, 2012

Rising abuse has doctors pushing for fewer painkiller prescriptions

If you have a condition or injury that leaves you in non-stop pain, for months or years, your doctor might prescribe a powerful painkiller, such as Vicodin or OxyContin. Many doctors are looking for alternatives to these narcotics, and they're sharing approaches this week at a “National Opioid Summit” in SeaTac. 

Concerns about painkillers are rising, because abuse, addiction and overdose deaths are up.

The numbers of people getting prescriptions began rising rapidly in the 1990s, and since 2001, prescriptions increased fivefold. Pain specialists have been telling everyone, these medications called opioids are safe and effective, and are a great solution for long-term pain relief. 

“They made claims for safety that just haven’t panned out over time,” says Michael von Korff, who studies pain-relief at Group Health Research Institute.

The more drugs such as OxyContin are prescribed, he says, the more overdose deaths there are every year. In theory, many of those pills are making their way to addicts, and many people getting prescriptions aren’t well-monitored.

Reversing course

So, the pendulum is swinging the other way.

“We need to change practice in direction of safer, more cautious, more selective prescribing, and monitor what happens and see what we can learn,” says von Korff.

Group Health overhauled how its own doctors prescribe painkillers two years ago, and says it was able to cut back the number of pills while also improving patient satisfaction.

At the summit this week in SeaTac, they’ll share that model with other doctors and discuss whether their example could become a guideline for all medical practices. Researchers at the University of Washington have also developed a more cautious model for prescribing opiates.

These efforts dovetail with a new state law that took effect this year. It requires careful monitoring for anyone on high doses of painkillers, or for more than 90 days.

Chilling effect on doctors?

However, some pain specialists are concerned the reformers could go too far, and put a chill on doctors willingness to prescribe painkillers.

For example, many of the speakers at the summit have signed a petition asking the Federal Drug Administration to change the official label on these opiate drugs. The new label would say they’re intended only for severe pain, not moderate pain, and for less than 90 days.

Physicians could still prescribe them for longer, and for less severe cases, but that’s called “off-label” prescribing.

“As medical legal issues get worse, physicians are more reluctant to go off label, so I think it would put a chill on physicians willing to prescribe opioids,” says Charles Chabal, a pain specialist at Evergreen Hospital in Kirkland, a former researcher at the University of Washington, and the current president of the Washington Academy of Pain Management.

Chabal says in small towns, there may not be a specialist for a family doc to consult. And those primary care physicians may refuse to prescribe the painkillers.

He’s warned about the over-use of opiates for many years, but he says opiates do have their place.

This debate over painkillers is likely to continue for years to come, because there’s no definitive research – no large, controlled study – about safety or effectiveness.