August 15, 2016

Senators Gillibrand And Capito Urge President Obama To Take Action To Require CDC To Issue Guidelines For Prescribing Opioids For Treatment Of Acute Pain

Earlier this year, Gillibrand and Capito introduced bipartisan Preventing Overprescribing for Pain Act to help combat the opioid epidemic / Senators urging Obama Administration to address opioid epidemic and develop, publish guidelines for doctors prescribing opioids for acute pain

Washington, D.C. – U.S. Senator Kirsten Gillibrand (D-NY) and U.S. Senator Shelley Moore Capito (R-WV) sent a bipartisan letter urging President Obama to use his administration to develop and publish guidelines for prescribing opioids for acute pain treatment. Currently, the CDC is focused primarily on opioid prescribing guidelines for the treatment of chronic pain. However, many individuals become addicted to opioids after taking prescriptions for acute pain, such as a broken bone or wisdom tooth extraction.

“Prevention of overprescribing or inappropriate prescribing of opioids is a key component to combating the opioid epidemic. By developing and publishing a comprehensive guideline for prescribing opioids for the treatment of acute pain, we can minimize the initial exposure to opioid medications and further limit diversion of opioid prescriptions, which can have positive downstream effects on combating opioid abuse,” the Senators wrote in the letter. “Similar to CDC’s development of the Guideline for Prescribing Opioids for Chronic Pain and the other ways in which your administration has taken initiative to use administrative authority to address the opioid epidemic, we encourage your administration to use its authority to develop and publish comprehensive guidelines for prescribing opioids for the treatment of acute pain.”

In February 2016, Senators Gillibrand and Capito introduced S.2567, the Preventing Overprescribing for Pain Act, which would require the CDC to issue guidelines for prescribing opioids for the treatment of acute pain. The CDC does not need an act of Congress, however, to develop and publish guidelines for prescribing of opioids for the treatment of acute pain. The Obama Administration has taken initiative in the past to use administrative authority to address the opioid epidemic and could use its authority again to develop and publish comprehensive guidelines for prescribing opioids for the treatment of acute pain.

The full text of the letter is included below:

The Honorable Barack Obama

President of the United States

The White House

1600 Pennsylvania Avenue

Washington, DC 20500

Dear Mr. President,

Thank you for your commitment to addressing the opioid epidemic currently gripping our nation. We were encouraged by the new initiatives that your administration announced on July 6, 2016. These efforts will help to reduce opioid abuse and enhance access to much-needed care for individuals with opioid use disorders.

We are writing today to bring your attention to another critical area related to opioid abuse: the prescription of opioids in the treatment of acute pain. It is widely known that part of the opioid epidemic can be attributed to an overabundance of opioid prescriptions written by health care providers, and substantial research exists linking the use of opioids for chronic pain with opioid addiction. As there are now more than 2 million Americans suffering from an opioid use disorder, it is critical that prescribers thoughtfully and responsibly prescribe these powerful narcotics. Earlier this year, the Centers for Disease Control and Prevention (CDC) published the CDC Guideline for Prescribing Opioids for Chronic Pain (“Guideline”) to provide recommendations to primary health care providers regarding prescribing opioid pain medication to treat chronic pain in adults.

However, not all individuals with opioid use disorders began misusing opioids after receiving a prescription for chronic pain. For many, their difficulties with opioid addiction began after receiving an opioid prescription for acute pain. For example, a study published in the Journal of the American Dental Association found that 64% of surveyed dentists preferred prescribing hydrocodone with acetaminophen for patients to use as needed after a wisdom tooth removal—a procedure common in young adulthood—for an average of 20 pills per prescription. These researchers recognized that a 20-pill prescription may be more than necessary, and that writing prescriptions for larger numbers of pills, when only a few pills will suffice, may cause patients to misuse the remaining pills.  One example of misuse is diverting or giving away pills to another person. Indeed, countless studies have shown that some teenagers divert these excess pills to their friends. Moreover, the National Institute on Drug Abuse (NIDA) reports that adolescents who abuse opioids are more likely to receive these medications from a friend or family member.

Another recent study utilizing data from NIDA found that teenagers who received an opioid prescription by Grade 12 were 33% more likely to abuse opioids after high school. Perhaps most striking, these researchers found the risk for opioid abuse was even higher among teenagers who reported little to no previous use of illicit substances. For these teenagers, this opioid prescription may be their first introduction to addictive substances. That it is prescribed by a physician may create the notion that the substance is “safe,” leading to misuse of the substance.

Overprescribing of opioids for acute pain is therefore potentially problematic in two ways. First, individuals with acute pain, particularly those who have not had previous exposure to any illicit substances, may be at heightened risk to abuse or become addicted to these substances in the future. This trend may be particularly relevant for younger patients. Second, as the research has shown, these prescriptions contribute to the available supply of opioids and are frequently and inappropriately diverted to others. More research on opioid prescriptions for acute pain and its relation to illicit opioid use would further illuminate these potential paths to addiction.

The Guideline for Prescribing Opioids for Chronic Pain (“Guideline”) includes a recommendation related to the prescription of opioids in the treatment of acute pain. However, this recommendation is buried among eleven other recommendations within the frame of a guideline related to prescribing opioids in the treatment of chronic pain. In fact, the Guideline says, “Some of the recommendations might be relevant for acute care settings or other specialists, such as emergency physicians or dentists, but use in these settings or by other specialists is not the focus of this guideline.” The Guideline then refers readers to other sources for prescribing recommendations within acute care settings and in dental practice. However, each of these other sources are limited in scope and do not provide the comprehensive approach that CDC was able to bring to bear with the Guideline for Prescribing Opioids for Chronic Pain. Further, the Guideline is intended to be used only with regard to adult patient populations, whereas adolescents in particular may be particularly vulnerable to exposure to opioids through a prescription to treat acute pain or the diversion to others of such a prescription.

Earlier this year, we introduced S.2567, the Preventing Overprescribing for Pain Act, which would require the CDC to issue guidelines for prescribing opioids for the treatment of acute pain. This bill was included in the Mental Health Reform Act of 2016, which the Senate Committee on Health, Education, Labor, and Pensions passed unanimously in March 2016. While we are hopeful that the Senate takes up and passes the Preventing Overprescribing for Pain Act this year as part of the Mental Health Reform Act of 2016, this bill does not need to pass in order for the CDC to develop and publish guidelines for prescribing of opioids for the treatment of acute pain. Similar to CDC’s development of the Guideline for Prescribing Opioids for Chronic Pain and the other ways in which your administration has taken initiative to use administrative authority to address the opioid epidemic, we encourage your administration to use its authority to develop and publish comprehensive guidelines for prescribing opioids for the treatment of acute pain.