Van Wey, Metzler & Williams

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Do We Really Need a Dangerous, Deadly Pain Killer?

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Chronic pain affects tens of millions of people in the U.S., and doctors are more likely to recognize and treat this pain more than they have ever been.

The number of prescriptions for opioids has increased 10-fold since 1990. Chronic pain, which affects tens of millions of people in the United States, is associated with functional loss and disability, reduced quality of life, high health care costs, and premature death.

U.S. physicians are now more likely to recognize and treat chronic pain than they have been historically, with the number of prescriptions written for opioids having increased 10-fold since 1990. However, over the same period of time, the overdose death rate in the U.S. has more than tripled. This is not by accident.

Many doctors have prescribed opioids without thoroughly analyzing patients. They either haven’t been clear on the risk for development of substance-use disorders, or haven’t recognized red flags that have emerged in clinical practice.

Evidence is now surfacing in several states that shows us opioids are leading some down the path to progression to heroin. Now Zohydro has entered the disturbing mix. Zohydro is a single-entity formulation of hydrocodone and joins the same category as these prescribed drugs:

  • Oxycontin (oxycodone hydrochloride)

  • Morphine sulfates (MS Contin, Avinza, and Kadian)

  • Exalgo (hydromorphone hydrochloride)

  • Opana ER (oxymorphone hydrochloride)

  • Nucynta ER (tapentadol)

  • Embeda (morphine sulfate and naltrexone hydrochloride)

Extremely high-potent Zohydro is sold in capsule form, to add to the danger, and can be crushed or snorted by abusers. FDA Commissioner Margaret Hamburg stated these broad attempts they are addressing regarding the addiction and overdose risks:

  • Moving hydrocodone preparations to the more restrictive Schedule II

  • Relabeling certain prescription opioids with new warnings and narrower indications

  • Promoting education of prescribers and patients about long-acting opioids

  • Seeking to accelerate development of effective nonopioid treatments for pain

Many people who experience chronic pain are at risk for addiction or overdose when treated with opioid medications. Managing these clinical situations effectively should be a significant focus of research funding today.

One such approach might involve a type of specialty fellowship in chronic pain and addiction developed to provide expertise and consultation to both clinicians and policymakers. The federal government can definitely do more to intercede in the concurrent treatment of chronic pain and addiction among patients who are at greater risk for both.

Why not designate the Substance Abuse and Mental Health Services Administration with the task of guiding physicians practicing in opioid-treatment programs on appropriate ways of using methadone or buprenorphine to treat concomitant opioid-use disorder and chronic pain?

Health care systems could include screenings, brief intervention, and referrals for further testing and treatment of addiction into all clinical settings where opioids can be prescribed. Medicare and Medicaid programs can use data-analysis tools to spot the red flags of inappropriate prescribing. They can then report these prescribers to medical boards and state agencies for further action.

No one wants to see medical malpractice occur. But when it does, the Van Wey, Presby & Williams team believes the medical community should be held accountable. If we take on your case, here’s what the process will look like… 

Clinical practices in the U.S. need to be reviewed with the aim of supporting high-quality care for both chronic pain and addiction. This way, physicians will not be deterred from treating patients with complex needs. New England Journal of Medicine also suggests: Public and private insurers can provide as generous coverage for treatment of opioid-use disorder as they do for management of chronic pain. This standard is infrequently met.

The FDA needs to provide a set of reasonable requirements for opioid medications that will deter others with less expertise from filling a perceived void. Everyone involved in the medical and pharmaceutical industry, as well as the FDA, must come together to promote high quality and effective prevention and treatment for chronic pain and addiction.

By: Kay Van Wey | January 3rd, 2016

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