New CDC recommendations aim to curb painkiller prescribing

Federal health officials, hoping to reverse the worst opioid drug epidemic in decades, on Tuesday issued new guidelines to address chronic pain, saying doctors should first try non-pharmaceutical methods — even old-school medicationslike aspirin — before considering the most addictive compounds on pharmacy shelves.

“Finally. At last,” said Dr. Jeffrey Reynolds, a leading Long Island expert in the treatment of substance abuse and chief executive of the Family & Children’s Association in Mineola.

“It’s never too late,” Reynolds said. “Although two decades’ worth of crises is a long time to wait for the nation’s public health authority to speak out. But I am glad that the feds have finally weighed in on this.”

The new guidelines, although nonbinding, initially were scheduled to be made public in January, but were embroiled in a heated dispute. The prescription drug industry and associations representing pain-management doctors didn’t want them released. Industry officials and physicians argued that tightening the standards on prescribing narcotic medications might construct roadblocks for patients who need them.

But federal officials Tuesday said the population in genuine need of opioid medications is far smaller than most doctors have been led to believe.

In announcing its new guidelines, the Centers for Disease Control and Prevention trained a spotlight not only on a growing drug-abuse catastrophe, but on the role primary-care prescribers have played in fueling it.

Primary-care clinicians, according to the CDC, write about half of all prescriptions for heavy-duty narcotics. And in 2014, agency officials said, nearly 200 million prescriptions were written for medications such as OxyContin, Vicodin and Percocet, compounds that persist at the core of a nationwide epidemic of addiction — and crime.

On Long Island, the addiction epidemic has become intimately intertwined with the sales of black market street drugs and a litany of underlying felonies that range from thefts of doctors’ paper prescription pads to pharmacy holdups and murder.

The new federal guidelines call for urine tests of patients before they are prescribed a narcotic painkiller, enabling physicians to spot “doctor shoppers,” addicts who obtain prescriptions from more than one clinician.

When patients receive opioid prescriptions they should be at the lowest possible dose for the shortest possible duration, no more than three to seven days, federal health officials said.

Dr. Shaheda Quraishi, a pain-management specialist at Northwell Health in Great Neck, said opioid-class medications are inappropriate for chronic pain.

“They should be the last thing that you turn to,” she said. “There are good indications for opioid medications: If someone has been in a traumatic car accident, or a patient has had surgery.”

Quraishi said antidepressants, anticonvulsants, anti-inflammatories and muscle relaxants work much better on chronic pain than opioid drugs. Federal authorities Tuesday recommended physical and behavioral therapies as well as the old medicine cabinet standbys, ibuprofen and aspirin.

Federal experts said there is an important role for opioids in the treatment of cancer pain and end-of-life care. Outside of those critical treatment areas, CDC director Dr. Thomas Frieden said opioid-class medications can be risky because of their addictive properties.

Frieden acknowledged Tuesday that even he received inadequate training in the prescribing of opioids during medical school.

Despite the nonbinding nature of the guidelines, some experts called them a “a game changer,” because they can help reverse several devastating trends.

“These are sound guidelines,” said Dr. Andrew Kolody, a specialist in the treatment of addiction who heads Physicians for Responsible Opioid Prescribing in Manhattan.

Outside of crimes, Kolodny said overdoses, and other problems related to addiction, have caused an overall decline in life expectancy among Caucasians in the United States, the population hardest hit by the prescription-drug epidemic.

“This is a very disturbing trend,” Kolodny said. “Middle-aged white people have had an increase in their death rate because of opioid addiction.”