Efforts to Control Opiate Abuse shift to Doctors Who Prescribe Painkillers
[Posted on: Thursday, 31 March, 2016]

March 2016 will likely be known for a myriad of actions taken by the US government to deal with drug overdose caused by prescription painkillers. First CDC released a new guideline for doctors who prescribe painkillers, followed by two new guidance documents by FDA, one adding a new black-box warning on all opioid painkillers, and second requiring generic manufacturers of a given opioid drug to have abuse deterrent measures similar to the reference drug. To cap it all, this week, President Obama announced a new $1.1 billion initiative to increase prescription of opioid overdose reversal drugs. The President also announced that more than 60 major medical schools in the US have committed to increase education in non-opioid pain management and to encourage doctors to prescribe such medication as the last resort after all other non-opioid methods have failed. Painkillers are an important component of disease management. Patients increasingly ask for and doctors prescribe a variety of painkillers. Most prescription painkillers contain habit-forming opioids. About three times as many people are addicted to painkillers in the US than those addicted to heroin, and prescription drug overdose accounts for about twice as many deaths than heroin overdose. By some estimates, the US population consumes about 85% of all opioid painkillers in the world. With these measures the government acknowledged that previous efforts which mostly involved educating patients have not succeeded. So, now the burden of responsibility is moved to doctors. The assumption is that the opioid epidemic can be controlled if doctors prescribe fewer opioid painkillers. Additional practices such as electronic prescription to avoid addicts forging paper prescriptions, increased use of pain management methods such as physical therapy, exercise and OTC painkillers which are always non-opioid medications, are expected to further reduce drug abuse. The effect of these measures on the drug industry might be minimal. First there are no additional curbs on sale and marketing of opioid-based painkillers. Second, there are no proposals for additional post-market safety reporting requirements or tracking of abuse for industry. More importantly, other than label changes to add warnings, industry is mostly untouched by this discussion. The CDC and FDA have tactically focused the attention from industry to prescribers. Drug abuse is increasingly considered a psychological issue rather than a criminal or law enforcement issue. It can be argued that the measure may have limited effect since patients are highly aggressive about getting painkillers to manage pain and may not agree with their doctors telling them to exercise or use physiotherapy over medication. Also, while the relief brought about by prescription drugs is quicker and seemingly robust, that by non-medicated methods is slow and requires a lot of effort and discipline by the patients making it less appealing. We will find out in a few years if these efforts bear fruit or end-up just wishful thinking in the war on drug abuse.