The amount of opioids being prescribed for chronic pain — and the attempt to regulate it — is quickly becoming controversial. The road to limiting who can get their hands on prescription painkillers is going to be a long one.
Opioids are utilized routinely and effectively as a short-term analgesic treatment for acute pain conditions like those that occur following trauma, and for patients with painful terminal diseases such as cancer. In the late 90s, the pharmaceutical industry started promoting new opioid formulations for chronic pain conditions. What ensued was a slew of abuse and overdose deaths — and a call for tighter prescription painkiller regulation.
Opioids like Vicodin, OxyContin, Percocet, morphine, or codeine make life bearable for those who live with intense, chronic pain. The problem is that these drugs are narcotics; people abuse them to get high since they affect parts of the brain that cause feelings of euphoria. Abusers attempting to get past the slow release of the pills will crush and snort or dissolve and inject the meds, often leading to overdose. According to the Centers for Disease Control and Prevention, “The unprecedented rise in overdose deaths in the US parallels a 300 percent increase since 1999 in the sale of these strong painkillers. Late last year the CDC reported that annual overdose deaths from opioids (18,000) continue to be increasingly — and already phenomenally — higher than deaths from heroin (2,000) or cocaine (6,000). As a result, painkiller regulation has been a hot topic with the FDA for years.
The Painkiller Regulation Dilemma
With too many deaths and with huge healthcare costs resulting from opioid overdoses, the need for much tighter regulation is obvious. The problem is that doctors can’t always sense when a patient is becoming overly tolerant of or dependent on a drug, which can lead to overuse and overdose. While many believe plans for new restrictions in opioid prescription marks a turning point in combatting abuse, some fear those in legitimate pain will suffer as a result.
Doctors are put in a tough spot in the mess, not knowing when to stop prescribing drugs to patients who claim to be suffering from intense chronic pain. And even when doctors are stingy in the number of prescriptions they write, may patients “doctor shop” to fill multiple prescriptions for the same drug.
The FDA is taking steps to get drug companies to make drugs in ways that make them harder to abuse. Plans are in the works to possibly place new restrictions on Vicodin (which contains opioid hydrocodone) and similar prescription painkillers. The drugs could move from being Schedule III drugs to Schedule II, meaning doctors could only write 30-day prescriptions and could not write new prescriptions without patients coming back into the office. The FDA will continue holding hearings to review the issues with opioids – and how to address the abuse problems — in the coming weeks.
Researchers are attempting to reformulate painkillers to make the drugs non-addictive. The hope is that this could put an end to opioid problems — problems like the 12 million people who admitted to using painkillers for non-medical reasons in 2010. If opiates can be reformulated to control pain without creating the risk of addiction, then drug regulators, doctors, and those who depend on opiates to manage pain may be able to breathe easier.