The overprescribing of opioids has been slow to turn around, Dr. Franklin said, because physicians lack alternatives and in many cases it is easier to simply write a prescription. Potentially helpful alternative treatments such as cognitive behavior therapy or multidisciplinary pain care are not always covered by insurers, he said.
Dr. Gary M. Franklin
“I feel like there has been a tipping point, but that still doesn’t mean that it’s going to reverse soon,” he added. “There’s still going to be a lot of lives lost.”
In the position statement, Dr. Franklin proposed a regimen for doctors that could help limit the amount of opioids prescribed, the length of such treatments, and their misuse. This would include a patient-doctor opioid treatment agreement, prescreening for past drug abuse and depression, random urine testing, abiding by state Prescription Drug Monitoring Programs, and strict avoidance of sedative-hypnotics and benzodiazepines. The American Academy of Neurology recommends that all doctors consult with a pain management specialist before prescribing morphine-equivalent dosages of 80-120 mg/day.
Although measures have been taken by U.S. government agencies to crack down on long-term opioid prescriptions – such as the 2007 Risk Evaluation and Mitigation Strategies implemented by the Food and Drug Administration and the Drug Enforcement Agency’s 2010 decision to restrict e-prescribing of opioids – Dr. Franklin said that there is still much to be done.
“Ongoing research and data collection regarding opioid efficacy and management are needed, as well as revision in state and federal laws and policy” to ensure patient safety, Dr. Franklin wrote.
He reported no relevant financial disclosures.