Opioids Still Prescribed Too Much, New Government Report Says

Patients are still getting too many opioids to treat their acute pain because of inconsistent prescribing guidelines despite a push to significantly lower pain pill prescribing in the U.S., an FDA-sponsored report released Dec. 19 found.

Acute pain is one that a patient feels for no longer than 90 days. Although there’s a bevy of opioid prescribing guidelines floating around, the National Academies of Sciences, Engineering, and Medicine found a lot of them don’t have rigorous evidence to back them up. That’s an issue the federal government has tried to rectify in the last few years, but there’s still a dearth of data on how to best treat pain that comes from everyday procedures like dental surgery.

The biggest reason better guidelines are needed is because the U.S. still leads the globe in opioid consumption. In 2010, the U.S. consumed approximately 80% of world’s opioid supply despite constituting less than 5% of the world’s population, research found. Dentists in the U.S. prescribe opioids 71 times more frequently than their counterparts in the U.K.

Surgical procedures that need better prescribing guidelines include cesarean delivery, total knee replacement, and wisdom tooth removal, researchers found. Pain from lower-back issues, sickle cell disease, migraines, and kidney stones also need clear guidelines. Those procedures were targeted because they’re common and current pain pill prescribing guidance for them has a lot of variation.

Clinical prescribing guidelines need to be backed by hard evidence, like randomized controlled trials, observational studies, and quality improvement initiatives, the report said. Guidelines also must be clear so they’re not misinterpreted, like 2016 guidelines from the Centers for Disease Control and Prevention. That policy caused a backlash from chronic pain patients when they were “inappropriately used to support policies by other organizations for mandatory opioid tapering,” the National Academies said.

Addressing the opioid crisis should be about finding appropriate pain pill prescribing methods while making sure people who need opioids can get them, Janet Woodcock, the director of the Center for Drug Evaluation and Research at the Food and Drug Administration, said Dec. 19.

“That’s why it’s important that we re-examine how opioid analgesics are being prescribed and help to ensure that health care providers—who are the gatekeepers to prescription opioid analgesics—are provided with the most current and comprehensive guidance on the appropriate management of pain,” she said.