CDC Says Doctors Overprescribe Painkillers

It’s often a reflexive response: When we hurt, we take a pill for relief. Last week, Dr. Tom Frieden, director of the U.S. Centers for Disease Control and Prevention (CDC), said, essentially, we have gone too far. By “we,” he means patients and doctors.

As described by the Los Angeles Times, Frieden criticized doctors for treating aches and pains with narcotics. Too many doctors prescribe these dangerous drugs too soon, too frequently and for too long. Such practice, he said, puts patients at risk of addiction and overdose.

In a conference call with reporters last week, Frieden referred to a study by the CDC showing that deaths due to prescription pain pill addiction have quadrupled among women since 1999.

Although more men die of overdoses from drugs like OxyContin, women are catching up quickly; according to the CDC, since 2007, more women have died from drug overdoses than from motor vehicle–related injuries. The problem is more acute among white women than black women, and among older women harder than younger ones.

The rise in overdose deaths among middle-aged women might be attributable to the fact that they are more likely to suffer from chronic pain and to be prescribed painkillers.

“Mothers, wives, sisters and daughters are dying at rates that we have never seen before,” Frieden said. “These are really troubling numbers.”

In The Times story, Frieden said that doctors are relying on these powerful drugs to treat chronic pain when exercise, physical therapy and other treatments would be safer and often more effective.

“These are dangerous medications, and they should be reserved for situations like severe cancer pain,” Frieden said. “In many other situations, the risks far outweigh the benefits. Prescribing an opiate may be condemning a patient to lifelong addiction and life-threatening complications.”

The FDA is considering new controls on how doctors prescribe and manufacturers promote narcotic painkillers such as OxyContin, Vicodin, Percocet and similar meds. In a series about overdose deaths (see our blog, “Suggested Reading: Several New Takes on the Dangers of Prescription Drugs,”) the L.A. Times’ analysis of more than 3,700 overdose deaths in Southern California from 2006 to 2011 showed than nearly half involved a drug prescribed by a doctor.

The number of deaths from drug overdoses surpassed fatal traffic accidents in 2009; it’s one of the few causes of death that’s getting worse. In 2011, the CDC called the problem an epidemic.

Doctors used to avoid narcotics to treat pain except for cancer and hospice patients. They feared addicting people to the drugs. Nearly two decades ago, according to the L.A. Times, those fears began to subside in the wake of a movement to alleviate suffering among people with noncancer pain. New painkillers were thought to be less prone to abuse. Doctors began writing prescriptions for them to relieve toothaches and arthritis.

Frieden called on doctors to weigh the risks of addiction and overdoses more carefully against the severity of their patients’ pain. He said they also should determine if they have a history of substance abuse, and reiterated the CDC recommendation that doctors check prescription databases to ensure that their patients are not “doctor shoppers.”

As The Times notes, the CDC does not determine drug policy-it’s an information and advisory body. But its research and recommendations influence the FDA, law enforcement agencies, doctors and local public health policies.

To read the story of how one woman got hooked on painkillers, see this article in the New York Times.

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