National Pain Strategy for Opioids and Other Medications

Orlando—A 2011 report from the Institute of Medicine (IOM) found that chronic pain affects 116 million people in the United States, more than the total affected by heart disease, cancer, and diabetes combined. The disease also costs the healthcare system $635 billion annually.

Based on a recommendation in the IOM report, the Department of Health & Human Services and other government agencies created a National Pain Strategy task force that oversaw and coordinated 5 working groups focused on: (1) professional education and training; (2) public education and communication; (3) public health care, prevention, and disparities; (4) service delivery and reimbursement; and (5) population research. 

Steven Stanos, DO, member, service delivery and reimbursement working group, who spoke at the NAMCP forum, said results and recommendations from the National Pain Strategy will likely be released this summer. This session was supported by an educational grant from Purdue Pharma and Teva Pharmaceuticals.

“We are hoping it will have some type of impact,” said Dr. Stanos, medical director, center for pain management, Rehabilitation Institute of Chicago. “Hopefully the time is right that all of these groups are willing to change.”

In recent years, the problems associated with pain medications have received national attention. Dr. Stanos mentioned data from the Centers for Disease Control and Prevention that found there were 16,651 overdose deaths from prescription painkillers in 2010, more than 3 times more than in 1999.

Furthermore, nearly 1 million people ≥12 years of age took opioids for nonmedical purposes for >200 days in 2009 and 2010, while 4.6 million used opioids for nonmedical purposes for ≥30 days. The highest rates for prescription painkiller overdose rates were in middle-aged adults, people living in rural counties, and white, American Indian, or Alaska natives. The direct healthcare costs of nonmedical prescription painkiller use were $72.5 billion annually.

Dr. Stanos cited a 2009 survey from the Substance Abuse and Mental Health Services Administration that 55% of respondents said they abused drugs after receiving them free from friends or relatives. The second most common place where people who abuse drugs received them was prescriptions from their doctor (18%).

In July 2012, the FDA approved a Risk Evaluation and Mitigation Strategy (REMS) for extended-release and long-acting opioids, such as hydromorphone, methadone, meperidine, oxycodone, fentanyl, morphine, opium, and codeine, that are indicated for daily, around-the-clock, long-term opioid treatment when no alternative treatment options are adequate. The FDA wants the number of prescribers of extended-release and long-acting opioids who participate in the REMS program to increase from 80,000 in 2015 to 160,000 in 2016 and 192,000 in 2017. However, Dr. Stanos said the training is voluntary for physicians, and they may have a difficult time determining who could misuse or abuse prescription medications. Extended-release and long-acting opioids are schedule 2 drugs, which means they are associated with potential abuse that may lead to moderate or low physical dependence or high psychological dependence.

Still, there are biological, psychiatric, and social risk factors for aberrant behaviors related to prescription painkillers. Before prescribing the medications and during the treatment period, Dr. Stanos recommended providers assess substance use and psychiatric history, use screening tools, and counsel patients to read the medication guide, take the drugs exactly as prescribed, store the drugs in a safe place, and call providers for medical advice about side effects.