Opioid addiction is a major health issue with 1.9 million people addicted to prescription pain killers and another 600,000 addicted to heroin. This results in 19,000 overdose related deaths and 10,500 heroin related deaths annually. The Centers for Disease Control recently came out with new guidelines to help reduce the risk of opioid abuse or death which offers some stringent recommendations which are starting to be adopted by some state legislatures and Connecticut is considering action as well.
The CDC worked with an Evidence-based Practice Center, like the one at UConn, to conduct a comprehensive review of all the studies that have been conducted on opioid use for acute and chronic pain. This review showed that most acute pain, from injuries or surgical procedures, only require 3 to 5 days of therapy before pain can be managed with nonopioid options. However, this is different than standard practice where 14 to 30 days of opioids are usually given to patients. Prolonging use past the time when it is needed increases the risk of addiction and having extra pills around increases the risk they will be taken and used recreationally. Based on this evidence base, the CDC recommends dispensing no more than 7 days of prescription pain reliever therapy to patients for their initial prescription and to be reevaluated before deciding whether or not to write a new prescription for prolonged therapy. The other main finding was that chronic pain from diabetic neuropathy, osteoarthritis, or lower back pain is not well managed by opioid pain relievers and that physicians need to explore and try non-opioid therapies. From over the counter pain relievers, injections, antiseizure medications or antidepressants for nerve pain, and weight loss and low impact exercise for osteoarthritis and low back pain; doctors need to explore long term pain relieving strategies.
Massachusetts legislature has passed a bill and their Governor signed it into law limiting the patient’s first opioid prescription to 7 days and Connecticut is considering doing the same. Unless the doctor attests that a patient has special circumstances like pain associated with cancer or end of life care, you will need a new prescription to extend your opioid therapy should it pass. On the whole, legislation like this will be a net plus for Connecticut with less prescription opioids around to be diverted to illegal use and fewer people getting hooked while taking the drug for acute pain. However, there will be unintended consequences as well. For the working poor, taking an extra day off of work to see the doctor and get a new prescription or affording the copays for the extra visit and the prescription can be a barrier to access and leave them with uncontrolled pain. The 7 day hard stop means a prescription can run out on a Friday and the patient might not be able to get a new prescription until Monday leaving them without adequate therapy over the weekend. And finally, we have seen an increase in the number of people abusing heroin when the supply of prescription opioids dries up and this will definitely happen with this legislation as well. Over 90% of heroin abusers say they started using heroin when prescription opioids became too expensive or they couldn’t access it.