New guidelines: When you should—and shouldn't—prescribe painkillers

Risks outweigh benefits, specialty group says

The risks associated with using some narcotic painkillers far outweigh the benefits of using them for lower back pain, headaches, and fibromyalgia, according to new prescription guidelines from the American Academy of Neurology (AAN).

Such opioid painkillers include codeine, fentanyl, hydrocodone, methadone, morphine, methadone, oxycodone (commonly known as Oxycontin), and a combination of any of those drugs with acetaminophen. They can cause serious side effects such as addiction, overdose, and death. According to AAN, about 50% of patients who take opioids for at least three months are still on them five years later.

The states with the most opioid painkiller users

"More than 100,000 people have died from prescription opioid use since policies changed in the late 1990s to allow much more liberal long-term use," says physician Gary Franklin in the AAN statement.

He added, "There have been more deaths from prescription opioids in the most vulnerable young to middle-aged groups than from firearms and car accidents. Doctors, states, institutions, and patients need to work together to stop this epidemic."

Painkiller nation: How did we get here?

Moreover, there is no research to support that opioids improve patients' health beyond just short-term pain relief, without serious risk of dependence or overdose, the AAN statement says.

The guidelines—published in Neurology—outline ways for physicians to more safely prescribe opioids when they are needed.

For example, AAN recommends that physicians consult with a pain management specialist should a patient's daily opioid dosage hit 80 to 120 milligrams, especially if the patient has not shown substantial improvements in pain level and health.

When prescribing opioids, physicians should also consider screening patients for depression and past medication misuse, create an opioid treatment agreement with the patient, and use random urine drug screenings, according to the guidelines.

Hospitals prepare to accept patients' old drugs

"This is the first position paper by a major American specialty society saying that there is a real problem here and the risk might not be worth the benefit for certain conditions," Franklin says, adding, "More research and information regarding opioid effectiveness and management is needed, along with changes in state and federal laws and policy to ensure that patients are safer when prescribed these drugs" (Preidt, HealthDay, 9/29; Park, Time, 9/29).


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