An Essential Look into the Prescribing of Opioids

Pain – by the Numbers

The National Health Interview Survey 2019 indicated that approximately 20.4% of U.S. adults suffered from chronic pain. Age groups, gender, race, and location differentiate the statistics:

• White adults (23.6%) were more likely to suffer from pain than non-Hispanic black (19.3%), black (13%), and non-Hispanic Asian (6.8%) adults.
• Women (21.7%) were more likely to suffer from chronic pain than men (19%).
• Adults over age 65 (30.8%) had the highest likelihood of chronic pain compared to other age groups.
• Adults living in a rural area (28.1%) were more likely to suffer from chronic pain when compared to adults living in an urban metropolitan area (16.4%) (Zelaya et al., 2020)

CDC Recommendations for Prescribing Opioids

In 2016, the Centers for Disease Control and Prevention published in-depth recommendations for prescribing opioids that included these critical points:

• Prescribe nonpharmacologic and nonopioid therapies over opioid prescriptions. If prescribed, combine opioids with nonpharmacologic and nonopioid therapies.
• Prescribe the lowest effective dose when prescribing opioids.
• Evaluate risk factors for opioid-related effects or consequences when prescribing, as well as periodically during treatment.
• Conduct recommended urine drug testing before prescribing an opioid, as well as periodically during treatment.
• Indicate medication-assisted treatment with buprenorphine or methadone for patients with opioid use disorder (Clinical Practice Guideline – Opioid Prescribing for Chronic Pain, 2021).

Opioids: An Epidemic

In the late 1990s, drug companies assured the medical community that prescribing opioids and other controlled substances did not increase the risk of addiction. This assurance led to increased numbers of prescriptions for these medications. In 2017, the Department of Health and Human Services (HHS) declared a public health emergency; the United States suffered from an opioid epidemic (What is the U.S. Opioid Epidemic? 2021).

Due to the opioid epidemic, the process for prescribing and tracking narcotics has changed over the past several years. As we’ve already discussed, the CDC has specific recommendations for prescribing opioids. In addition, prescription drug monitoring programs (PDMPs) now exist.

PDMPs, electronic databases that track prescriptions for controlled substances, have several redeeming features:

• Universal use: all prescribers have access to PDMPs. However, they need to review the PDMP before prescribing. Some states require the use of PDMPs before prescribing a controlled substance.
• Real-time: pharmacists must update the PDMP when filling controlled substance prescriptions. Pharmacists update at varying intervals, but quick updates yield the most effective PDMPs.
• Actively managed: Additionally, state health departments access PDMPs to gain data, which allows them to understand, provide recommendations, and identify inappropriate prescribing.
• Easy to access: many facilities use an electronic health record (EHR) integrated with the PDMP. The EHR also allows other healthcare professionals to access the information if needed (Prescription Drug Monitoring Programs, 2021).