When it comes to the debate over what to do about the nation’s prescription opioid epidemic, there is a group of people whose voice on this topic typically doesn’t get the attention it deserves: patients who legitimately need strong painkillers who do not abuse opioids.
As federal agencies continue to explore ways to stem the opioid crisis, the FDA last week held a meeting focused on getting patients’ perspectives on chronic pain. Although a notice said the meeting was on drug development for chronic pain, the document also said the FDA was interested in hearing about barriers to getting medications.
While I fully support efforts to cut down on opioid abuse, I remain concerned that those efforts may impede patients’ ability to get medication that they legitimately need and do not abuse. At last week’s meeting, many patients said they feel they are being treated like addicts by some health care professionals. One woman who testified said that she has been unable to find a doctor to prescribe her opioid medication that provides relief for a painful condition she has, according to an NBC News report.
To be fair, the hesitation of many doctors to prescribe opioids is not the FDA’s fault. That blame is largely due to a 2016 CDC (Centers for Disease Control and Prevention) prescribing guideline that discouraged doctors from prescribing opioids for chronic pain.
Finding a Balance
FDA Commissioner Scott Gottlieb understands the balance that must be struck on appropriate use of opioids. Although he didn’t attend the meeting, he said in a statement that while in most instances, opioids should only be used for short periods to treat acute pain, there are situations – such as severe cancer pain – where opioids “may be the only drugs that provide relief from devastating pain.”
I agree with him. At MedShadow, we encourage people to take the smallest dose of a drug that provides relief and for as short a period as possible, to minimize potential side effects and adverse effects. We also explore non-pharmacological, alternative therapies that can potentially help. But for many patients with conditions characterized by chronic pain, other kinds of pain relievers, such as NSAIDs (non-steroidal anti-inflammatory drugs), may not work for them, and opioid medications may be one of their only options.
So what can the FDA do to help people with chronic pain? They should be doing more to encourage drugmakers – whether by financial incentives or other means — to develop new drugs that provide the relief opioids do but without the side effects and risks of addiction associated with them. Gottlieb’s statement refers to an innovation challenge to develop medical devices that treat opioid addiction and can provide pain relief. However, new medications may hold the greatest potential for pain relief.
They should also take a closer look at alternative therapies for pain relief before dismissing them. Earlier this year, the FDA issued a warning on kratom, a plant-based supplement used by many for pain relief, saying the herb is potentially addictive and linking it to 44 deaths. The agency appeared to downplay potential benefits of kratom – backed by scientific research — while not fully examining other factors in those deaths. In fact, a meta-analysis published in December indicated that kratom may not only be a safer alternative to opioids for pain relief, but it also has potential to treat opioid addiction itself.
The FDA can act on an idea that Gottlieb first mentioned in a May blog post. The commissioner wrote that the agency is considering developing a strategy to encourage professional medical societies to develop their own evidence-based opioid prescribing guidelines. This could be a good way to address the criticism surrounding the CDC prescribing guideline.
“Having sound, evidence-based information to inform prescribing can help ensure that patients aren’t overprescribed these drugs; while at the same time also making sure that patients with appropriate needs for short and, in some cases, longer-term use of these medicines are not denied access to necessary treatments.”
While those who have a legitimate need for opioid medications should be able to get them without inconvenience, they should also know that opioids are not the only way to control even severe chronic pain. Different forms of exercise, physical therapy, yoga and acupuncture are all ways to help lessen chronic pain. While they may not completely eliminate the need for opioids, they may help to lower the amount needed. And that’s a prescription we can all agree with.