Hooked On Painkillers – How Some States in the US Are Overcoming Their Nasty Drug Habit

opioid painkiller overdose oxycodone side effectsChronic back pain can lead to chronic painkiller use but it appears that if you live in Alabama you’re more likely to be prescribed opioid drugs than if you live in a northern state. A new analysis carried out by the US Centers for Disease Control and Prevention (CDC) found that for every 100 Americans there were 82.5 prescriptions written for opioid painkillers in 2012. In Alabama it was 143 scripts per 100 people. Why the disparity, and why should those with chronic back pain care?

Conditions such as spinal stenosis can leave people in considerable pain with little option other than to take analgesics to get through the day. Much of the time over the counter non-steroidal anti-inflammatory drugs (NSAIDs) or acetaminophen are sufficient to knock back pain on the head and get on with life.

However, these drugs are not free of side effects and for many they simply aren’t effective for long-standing pain caused by nerve damage or other effects of spinal stenosis. In fact, last week we reported how one recent study found that acetaminophen has no advantage over placebo when it comes to treating acute back pain.

Opioids are usually not recommended for those with chronic conditions as these painkillers are habit-forming. Instead, opioid analgesics are typically prescribed for acute pain, including sudden back pain or pain after back surgery to help in the short-term as a person recovers.

However, in many states, particularly those in the southern US, the risk of prescription drug overdose is much higher than in other states and so the CDC mounted an investigation into prescribing practices, wondering if variation in scripts could explain the disparity. What they found was that physicians are prescribing opioids much more regularly in Alabama, Kentucky, Tennessee, and West Virginia than in other areas of the US.

In fact, in 11 states, including those just mentioned, each adult was given at least one prescription for painkillers in 2012. Overdoses of drugs like Percocet and Vicodin now kill more people each year in the US than car crashes, but the risk varies considerably across the country. The difference in prescribing rates isn’t thought to be because people in the south-east US have more pain than anywhere else but that improper prescribing practices are exposing more people to the risks of opioid drugs.

Opioids for Back Pain?

Opioid drugs are not indicated in most cases of back pain and neck pain but where a person has tried many other methods of pain relief and is still suffering it may be that a physician does resort to such a prescription. Opioids are almost never considered first-line therapy for pain however and with 3,201 deaths from overdose in Florida in 2010 policy makers in the state decided that something had to change.

Cutting Opioid Overdose Deaths in Florida

Between 2010 and 2012 Florida brought in new regulations that targeted pain management clinics, as well as implementing restrictions on physicians dispensing opioids from their offices. In 2012 the annual number of overdose deaths had dropped by 16.7%, to 2,666, and the number of deaths from oxycodone fell by more than 50%.

Better Pain Management through Policy Changes

Although state-run databases for prescription-monitoring have been called an invasion of privacy by some it seems that other types of public health initiatives in Florida have saved lives by cutting opioid overprescribing. Patients in Florida may be getting better, more appropriate treatment for conditions such as chronic back pain from spinal stenosis as physicians can no longer rely on the ‘easy’ solution of writing a script for Vicodin.

Instead, looking at alternative ways of reducing pain or helping patients manage chronic back pain more effectively can be employed. It may also be helpful for physicians to consider how natural substances, such as resveratrol, have been found to increase the effectiveness of opioids so as to be able to prescribe a lower dose of these drugs when they are deemed necessary.

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