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CDC Issues New Guidelines to Address Opioid Epidemic

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The Center for Disease Control and Prevention has released new guidelines for opioid prescriptions in response to growing misuse of the drug. Opioid prescriptions are often the gateway to opioid abuse and dependence.

“More than 40 Americans die each day from prescription opioid overdoses; we must act now,” CDC Director Tom Frieden, M.D., M.P.H., said in a statement. “Overprescribing opioids – largely for chronic pain – is a key driver of America’s drug-overdose epidemic. The guideline will give physicians and patients the information they need to make more informed decisions about treatment.”

The CDC recommendations apply to opioid use for chronic pain, which is classified as pain lasting more than three months or beyond normal tissue healing time, according to the CDC. The guidelines do not apply to cancer patients, end-of-life care and palliative care.

In the guidelines, the main advice the CDC provides includes:

  1. When providers do prescribe opioids, they should be used at the lowest possible effective dosage.
  2. Try treatments other than opioids first. Other methods may include ice, Tylenol or ibuprofen.
  3. Providers should thoroughly explain risks of opioids to patients and ensure that they are understood. They should also closely monitor all patients.

According to the CDC, opioid overdoses have hit a record high in the United States. More than 47, 000 people died of drug overdoses in 2014, according federal data published in January 2016.

"In 2014, opioids were involved in 28,647 deaths, or 61% of all drug overdose deaths".

Like many Americans, I have had my own experiences with painkillers. Last summer, I found myself in deep pain. While walking in a parking lot, my left foot rolled on uneven pavement. There was not a popping sound, and I didn't fall.

Since I'm a runner, I assumed I could "walk it off." Once inside my office, I elevated my foot, yet, still it was throbbing. I decided to walk downstairs to get a bag of ice. Back at my desk, I elevated my foot, put the ice on it, and still the swelling continued. The pain was intense.

Hours later, I was in the emergency room at my local hospital where I got the diagnosis. I had a Jones fracture. Before I was even given crutches or a discharge summary, I was offered prescription-strength painkillers. I declined.

The medical staff insisted I take the prescription, but I never got it filled. Instead, I decided to take over-the-counter pain medication, ice my foot and not put any weight on it.

I don't have a history of abusing pain medication. However, I wanted to know the baseline for the pain so I could tell when my foot began to heal. I knew if I masked the pain with a prescription medication, it wouldn't give me an accurate picture.

Accidents like mine occur on a daily basis. People have surgical procedures and are given prescription painkillers to cope. Many patients choose to get their prescriptions filled, and unfortunately not all patients take their painkillers as prescribed. Leaving them available for others, such as children, to find and use may lead to an overdose.

If an injury or surgery occurs, it is important to talk about recovery options with your provider, without relying solely on prescription medications. Ask what other options are available.

Also, be aware that if you keep your prescription medication in an unlocked cabinet, there is the potential that others will consume them. Not everyone reacts to medication in an identical way. Just because you have never abused pain medication does not mean others will not. It is very important not to give away your pills to anyone.

If you have a chronic pain problem, seek out ways to avoid abusing or becoming dependent on prescription medication. Talking with your doctor about your fears of dependence or past abuse of medications is vital. Seeking professional help from a licensed therapist is also an option.

For a full copy of the new CDC guidelines, visit: http://bit.ly/CDC-opioid

Reviewed March 16, 2016
by Michele Blacksberg RN
Edited by Jody Smith

Add a Comment6 Comments

EmpowHER Guest

Melissa, I am the author of the above commentary, and for what it's worth, I chose to post anonymously because of the stigma that is often associated with the use of opiods even when prescribed by one's physician. Regardless, I did want to add that I have tried the TENS device and therapies on several occasions. I have been to numerous Phyical Therapists through the years as well. My physician has also attempted the use of accupunction as well. My phyician is a product of Duke's medical program with multiple specializations including Pain Management and Pain Medicine. I have turned down Oxycontin and Fentanyl in the past as while they are suggested for my condition they work too well and I like to feel some pain so I don't risk damaging myself further doing a physical activity that could worsen my condition. My concern with the government's involvement in something such as pain management is that each patient in individual and so is their pain. Without my meds, I would not be able to be involved in my children's lives, nor able to help out my spouse as one should. Whe someone suffers pain at these levels, there is great depression associated with it when there is no relief. I have talked to other patients in my circle, and they have indicated everything from buying illegal drugs to losing their desire for living should they be forced to go without their therapy and no longer have their pain relieved. Trust me, nobody who finds themselves on an opiate therapy wants to be there. It's the end of the line after everything else has been tried. Nothing is more depressing than under going multiple surgeries that do not work, and with the costs of healthcare today, I have known folks who have had to sell their homes! Don't get me wrong, I am a compassionate person and I feel for the lives of addicts and their families who are drug abusers, but why should we sacrifice the care of good citizens and make them suffer, or worse, for the actions of addicts who abuse these drugs and suffer the consequences. Regards the suggestion of NSAIDs, it's right there with the other methods towards pain relief mentioned above, if they worked than the problem would be solved. Nobody, except addicts who have mental health issues similar to alcoholics, would want to live on opiates if they hadn't already tried NSAID options as well. Sincerely. F.R.

March 19, 2016 - 6:37pm
EmpowHER Guest

I am a pain managed patient. Without my prescriptions, I will be on the couch or bed, in pain, unable to walk. Unable to drive my kids to school, unable to walk with my low-impact weights along with my wife and dog each night. Unable to participate in my life nor contribute to my country. I have been through every other option, electro-therapy, physical therapies, nerve numbs and kills, etc. My condition is non-surgical. The discs in my back are slowly fusing together and my neck is permanently damaged from a broken C1 that didn't take my life or capability to walk as it did Christopher Reeve, but instead left me with a lifetime of severe pain. Inoperable pain that is only numbed with opiate pain therapy. Thus, I am a long-term pain managed patient. I am regularly urine tested to make sure I am not taking any other drugs or alcohol, routinely subjected to pill counts to make sure I am not taking more than I should or sharing with others, subjected to a routine battery of physical and psychological testing to make sure the medicine there are no negative effects on my body or mind and so forth.

I cannot understand the CDC or what their agenda is regarding these new policies, or suggestions of best practices. We are told through the media that the legalization of marijuana in a few states along with the medical use legalization in even more states has resulted in a multi-billion dollar income deficit for the illegal drug cartels. However, it doesn't take much research in that same media to find out that pain managed patients who can no longer afford their prescription drugs, whether it is due to ObamaCare or some other cost increasing mechanism, are turning to illicit drugs for pain relief, particularly HEROIN. Many deaths from heroin overdose, either due to potency issues or bad additives in these sorts of street drugs have increased radically over the past few years. Suffice to say, it's a policy that all buts assists in making up the lost revenues suffered by the drug cartels around the world, and at the same time abandoning the quality of life for millions of law abiding Americans who depend on their doctors to offer them the care and compassion dictated as a priority by their profession. And let's not play ignorant with the weight of quality of life, we have lost so many good souls to suicide because they could not tolerate the physical pain, true agony, in their lives. Is the CDC willing to accept the fallout of their new recommendations? Remember, we are not talking about street addicts who will kill for their crack, heroin or PCP addicts. We are talking about millions of Moms, Dads, Brothers, Sisters...family. Law abiding, productive, functioning, contributing Americans who use these medications when no other options exist. I can tell you, as a pain managed patient, there is no shame in using these medications, not to mention that when you are on these meds long-term, the myth of a "high" or some sense of euphoria is just that, taking medicines like oxycodone, oxycontin, hydrocodone, etc. do not present one with any such feelings long term. A natural tolerance develops and it's just like taking an aspirin each day, you only notice that your pain levels are greatly reduced.

And on the topic of aspirin, it's comical to pain managed patients to read CDC pundits and their supporters in recent press suggest aspirin and ibuprophen (brand name Motrin) for managing pain. Aspirin in can cause internal bleeding if taken long term and in any sort of quantity. Tylenol (or acetaminophen) in quantity is proven to cause liver damage, as well. It's a sad tale of ignorance when we look at such replacement therapies, as well as when we look to the accidental celebrity overdoses incurred over the past decade. When coroners look at cases such as Heath Ledger and find massive quantities of drugs such as Xanax and Hydro- or Oxycodone in their systems we can't reach any other conclusions other than stupidity or a suicide attempt but we most definitely look to these people's deaths as to reasoning for removing such medications from the market. All one needs to do is ask, "how many accidental overdoses do we see with pain managed patients who use such medications?" The answer is negligible because pain managed patients are just as serious, just as educated and just as cautious as are self-medicating patients such as diabetics or any other patient who is forced to take any medication on a regular basis to improve their quality of life. Just ask yourself this, would we consider taking that diabetics medication away from them because a group of people have found away to abuse that medicine for "recreational" purposes thus leading to their demise.

Emergency Rooms are seeing greater numbers of "accidental" overdoses because drug addicts are abusing a medication that helps millions of Americans to lead normal lives, just as those same ER's see overdoses for cocaine, heroin and other drugs which are being abused by those people on the fringe who choose to abuse drugs instead of responsibly using them if they should be using them at all. It's time for Americans to be responsible for their own actions instead of making those who are, suffer the consequences of those who aren't, particularly when it directly impacts one's ability to live with less pain, and thus contribute to life and enjoy their life, something all Americans have a right to.

March 16, 2016 - 11:47pm
HERWriter (reply to Anonymous)

Thank you for taking the time to comment Anon.  I too find the new regulations to not be appropriate for chronic pain patients.  It would be different if first there had been a major amount of money spent to research and provide alternatives for those who need regular pain medication.  This is a bit of the cart before the horse.

 My best suggestion is to seek physical therapy to see if working with an experienced therapist may afford you some relief.  They can instruct you in the use of TENS machines or other treatments.  Seek pain management doctors who may use other treatments such a nerve blocks or ablation therapy of a nerve tract to reduce your pain or compounded topical medications that may provide relief.   There is also Lidocaine patches and NSAID patches as well.

take care,


March 18, 2016 - 5:23am
EmpowHER Guest
Anonymous (reply to Michele Blacksberg RN)

Michele, I authored the opinion to which you responded and I wish to add that I have been through the alternatives you suggested along with many others. The TENS device, acupuncture, a wide variety of various PTs and an assortment of non-opiate medications. My doctor specializes in Pain Management through use of all treatment opportunities from surgery to pain management via narcotic therapy. He has over 30 years of experience and is a product of Duke University and their medical programs there. His practice is very strict, and only patients from regional Primary Care physicians or other specialists who are unable to further assist in helping their patients may refer. There is no tolerance for mis-use or abuse when in the program. Patients are subjected to regular, mandatory drug tests, prescription counts, etc but his practice is the last line for those without other options. I can assure you my quality of life is improved and I am able to participate in the lives of my children and perform other responsibilities expected from a member of society. Without this therapy, my life would be extremely depressing. It frustrates me that those who have not experienced what I have had to go through make these sorts of decisions based on, primarily, the actions of those who abuse drugs, commit crimes and otherwise are without any responsibility to those actions. And I know many folks in my circle of patient support groups who feel the same way. They feel they are not being represented but instead our government is reacting to a negative situation instead of looking at the thousands of lives that have been saved or improved through opiate pain management. It's a bit of a disappointment. Sincerely.

March 19, 2016 - 5:26pm
EmpowHER Guest
Anonymous (reply to Michele Blacksberg RN)

Michele, you obviously don't understand chronic pain. Before one can even get an appointment with a pain management clinic or Doctor, we have already jumped them the hoops of physical therapy, tens unit's, massage therapy, which is Not Covered by insurance. Exercise routines, Tylenol, Aspirin, Motrin, Naprosin. Also acupuncture, mind therapy, a doc to check out our minds, are we faking it? Compounded medications, If insurance will pay. Then the pain management doc try's these procedures... Spinal injections, abulation, injections which deadens the nerve... Until it rerouted itself and causes pain worse than the original. By this point, most family and friends have stopped calling and caring, they know you don't feel well, but look normal. Society labels you as a faker, lazy, and depression has set in. It goes hand in hand w/pain. We keep trying to pick up the pieces of our lives. It is so difficult to want to be with people, when you hurt 24/7 and are always seeing doctors, having tests and no one helps or seems to care. Walk a day in my shoes... You probably won't make it until lunchtime. This pain world sucks, and special people now don't let doctors help, even if something might help, their hands are forbidden to even attempt it, in fear of losing their MD license.

March 18, 2016 - 8:36pm
HERWriter (reply to Anonymous)

To Anon #2 (not the original poster), I know quite a bit about chronic pain.  I am not in agreement with the changes in the regulations, I simply was trying to alert those who do not know to try these other options of small ways that may offer help.  

Insurance may pay for PT, Tens machines and but not massage therapy or acupuncture. It depends on the policy.  And if you have to go to a doctor to have a psych consult, so be it.  It doesn't matter if that is what is needed to get pain treatment. 

I don't know what your experience is with pain blocks with lidocaine and steroids or ablation of the nerve but there are plenty of people it has helped.

Ablation of the nerve basically removes (with heat or by freezing) some of the covering to interrupt pain signals. The covering does grow back but it take months and in that time the nerve has a chance to calm from sending those impulses.   The ablation can be repeated. It is a worthwhile option to look into. 

There are also drugs that block nerve impulses such as elavil or neurontin and many others that can be tried that are not narcotics. 

I feel your anger and frustration.  I am not your enemy. I am in agreement with how poorly those are treated with chronic pain.  


March 21, 2016 - 4:59am
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We value and respect our HERWriters' experiences, but everyone is different. Many of our writers are speaking from personal experience, and what's worked for them may not work for you. Their articles are not a substitute for medical advice, although we hope you can gain knowledge from their insight.

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