In the wake of an astonishing rise in prescription drug overdoses and deaths nationwide, the Centers for Disease Control announced plans in January to issue new guidelines for prescribing opioid pain relievers.
Prescriptions for opioid pain relievers have been steadily increasing in the United States for the last few decades. The CDC reports a 300 percent increase in opioid prescriptions written from 1999 to 2010, yet U.S. census data shows only a 10.9 percent increase in population in the same time frame. Additionally, the 2008 International Narcotics Control Board Report stated that the U.S. was responsible for consuming 99 percent of hydrocodone (Vicodin) and 83 percent of oxycodone (Percocet and OxyContin) worldwide.
So why the huge increase in prescriptions for opioids? Dr. Wanda Filer, President of the American Academy of Family Physicians, told NPR’s Robert Siegel on “All Things Considered” in December, “There was a campaign back in the late 1990s and early 2000s called Pain Is The Fifth Vital Sign, and many physicians were told, ‘you’re not paying enough attention. You need to be more liberal with opioid medications.’” “At the same time,” Siegel said, “extended release formulations of opioids were developed and marketed very aggressively, sometimes dishonestly. The makers of OxyContin were prosecuted for claiming the drug was less-addictive than it is. The company paid fines of $600 million.” According to a Feb. 2009 publication by National Institute of Health, executives at Purdue Pharma plead guilty to charges of misbranding OxyContin as being less addictive than other opioids. When Purdue Pharma first rolled out with the new drug, they more than doubled their sales representatives and increased their average annual sales bonuses to $71,500 (in addition to their yearly salary), nearly tripled the number of physicians on their call list, and even gave out coupons to patients for a free 7 to 30 day supply.
Purdue Pharma continues to bring in an easy $3 billion a year according to Forbes, mostly from the sale of OxyContin, still one of the most dangerous painkillers on the market. Purdue Pharma is owned by the Sackler family, one of the top 20 wealthiest families in the country with a net worth of $14 billion, conservatively.
The combination of recommendations for more medication in pain management and a stronger marketing push from the pharmaceutical industry created the perfect storm. In 2012, according to the CDC, 259 million opioid prescriptions were written, enough for every American adult to have a bottle of pills. In 2014, opioid overdoses accounted for 61 percent of the 47,055 drug related deaths in 2014, the worst year in U.S. history for drug related deaths.
What is being done about these astonishing numbers? The White House’s Office of the Press Secretary release a fact sheet in October of 2015 detailing dozens of new initiatives and improvements on existing ones. Federal health professionals will now be required to take opioid prescription training. Vast improvements in access to treatment of opioid addiction will also be made. After announcing plans for new guidelines regarding prescribing opioid medications, the CDC opened up a public comment forum in order to let health professionals and the public weigh in on what exactly the guidelines should be. They will then be peer reviewed by federal partners with the CDC, a core group of scientists and pain management specialists, and representatives from dozens of different national medical associations and societies.
Opioids are widely understood to be some of the most addictive substances on the planet, and yet they are also among the most effective at treating pain. This makes differentiating between patients who genuinely need them, i.e. patients suffering from acute or chronic pain, and those who don’t need them difficult for primary care physicians who do not have extensive training in pain management. It is important to understand that most people who require opioid pain medications use them responsibly, but tighter restrictions on prescribing them has the potential to cause people who need them undue suffering. This epidemic of opioid overdose and related deaths has made the discussion a necessary one.
