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Five Public Policies That Will Lead to Pain Relief Without Prescription Overdoses

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Major policy changes are needed to resolve the tension between providing adequate pain relief and tackling the epidemic of prescription opioid overdoses, according to drug policy expert Keith Humphreys, PhD. At the recent American Academy of Pain Medicine meeting, he laid out five policies that can achieve a realistic balance.

“Some of the policies are relatively easy to implement, while others involve changing cultural norms, which is much more difficult,” said Humphreys, Professor of Psychiatry and Behavioral Sciences at Stanford University School of Medicine, and a former Senior Policy Advisor at the White House Office of National Drug Control Policy.

According to the National Institute on Drug Abuse, from 1991 to 2009, prescriptions for opioid analgesics increased almost threefold, to more than 200 million. The Drug Abuse Warning Network system, which monitors drug-related emergency department visits and drug-related deaths, found that emergency room visits related to the nonmedical use of pharmaceutical opioids doubled between 2005 and 2009.

The five policies that Dr. Humphreys recommends are:

  • Implement prescription monitoring programs. “Some of the initial programs were slow and clunky, but we are now seeing systems, such as the one in New York, that are starting to make a difference,” he says.
  • Use the reimbursement power of insurance programs to lock “doctor shoppers” into a single prescriber. “If an insurer sees someone have five doctors writing them pain pill prescriptions, they can designate one provider as the patient’s pain doctor,” notes Humphreys.
  • Make prescription recycling a standard practice. “I remember when recycling bottles and cans was considered a strange thing, but now everyone does it,” he says. “Prescription take-back days won’t be fully effective until they become the cultural norm. Dropping off unused pills needs to be something everyone does when they go to the drugstore.”
  • Make it easier for drug companies to develop abuse-resistant drugs. “Pharmaceutical companies who are trying to do the right thing need to spend hundreds of millions of dollars to develop a pill that becomes inert when crushed, and then they have to apply for a New Drug Application. We need the Food and Drug Administration to create an accelerated review process for these new formulations.”
  • Change opioid-related medical practice. “We need to educate patients and providers that opioids are not the only treatment for pain,” Dr. Humphreys says. “There are other options, including different types of medications and physical therapy. We also need to educate prescribers in the emergency room and in dental offices that they shouldn’t automatically write a 30-day prescription for opioids. They have to start thinking about how much medication a patient really needs.”

With so many people dying of prescription drug overdoses, a response of doing nothing isn’t an option, he emphasizes. “I tell doctors that change is coming, and they can get involved, or else an uninformed policymaker may do it for them, with some potentially bad results.”

8 Responses to this article

  1. Avatar of Mary Walton
    Mary Walton / March 20, 2012 at 1:05 pm

    Prescribers also need to be educated on dependence and addiction. I often hear from patients that they were not tapered off pain meds and they end up buying on the street, which is a slippery slope as we know.

  2. Avatar of Howard Kornfeld, M.D.
    Howard Kornfeld, M.D. / March 18, 2012 at 7:29 pm

    An additional recommendation and a caveat:

    Buprenorphine, now FDA approved as a transdermal (Butrans), and inexpensive sublingual buprenorphine (FDA approved for addiction but readily prescribed off-label for pain) can be part of a logical and humane sequence where high-risk opioid dependent patients with chronic non-cancer pain can be rotated from full agonist opioids, such as morphine, oxycodone (OxyContin and Percocet), and hydrocodone (Vicodin, Norco).

    Let’s not limit the collaboration of the federal government to easing the marketing of new, expensive, and patented abuse-resistant drugs. Buprenoprhine is inherently abuse-resistant and also effective in a far wider range of neuropathic pain states and situations where opioids themselves become the vector of pain (opioid-induced hyperalgesia). Generic sublingual buprenoprhine needs public-private collaboration, without the golden pot at the end of the rainbow which fueled and continues to fuel Reckitt Benckiser and Suboxone (and which could discredit the field and the company in the same way that OxyContin tainted Purdue and the wise efforts of many pain physicians who used OxyContin skillfully).

  3. Josh / March 16, 2012 at 1:17 pm

    There is also the option of expanding the use of non-opiate pain medication like cannabis. There has never been a single reported death due to an overdose from cannabis.

  4. Joe Miller / March 16, 2012 at 3:14 am

    Dr. Humphreys is prescribing draconian restrictions that will only benefit the criminal predators that permeate the black market. His policies won’t be helping addicts and they certainly won’t help to decrease the crime and misery perpetuated against all Americans due to prohibitionist policies such as his own.

  5. Avatar of Roberoo
    Roberoo / March 14, 2012 at 7:52 am

    Couple a PMP with a clean UA prior to COT (chronic opioid therapy)and aberrant drug related behaviors are significantly reduced. Programs to treat chronic intractable pain patients, when terminated, send patients to the “dark side” to access pain control. Physicians need to know that they have nothing to fear if they practice good medicine when treating chronic pain. Increasing regulatory agencies only causes doctors to turn away chronic pain patients that have a legitimate claim to treatment/management. Many chronic pain patients do not have insurance which will cover alternative modes of treatment, and if they have been unable to work for an extended period of time, they can’t afford to pay for alternative treatment themselves. Cutting off all chronic pain patients because of the abuse of others, is not an answer, it is a serious omission.

  6. Steve Castleman / March 13, 2012 at 1:33 pm

    There’s a gaping hole in the policies advanced by Dr. Humphreys: where is the call for increasing addiction treatment?

    Addiction is a brain disease. Just like any disease, those afflicted require treatment, one patient at a time.

    Besides, as any addict can tell you, cracking down on prescription opiates will force addicts into the undergroung market where heroin is readily available.

    Steve Castleman

  7. Avatar of Dr. Jeffrey Reynolds
    Dr. Jeffrey Reynolds / March 13, 2012 at 1:00 pm

    Super recommendations. Here’s one more: one of the reasons docs write scripts for several months worth of meds is because patients want to avoid multiple co-pays. There is ample precedent for reducing/eliminating co-pays for a single script/condition (think $10 Lipitor co-pay card or prenatal care). Eliminate multiple co-pays and dole out pills on a monthly basis rather than handing over a 90-day supply.

  8. Avatar of M. Marden
    M. Marden / March 19, 2012 at 6:25 am

    Excellent response Roberoo. I am disabled due to two painful conditions. I can not afford the $45 copay for physical therapy living on Medicare and SSDI. I consider myself a responsible patient…I go to a well-run pain management facility where I willingly signed a contract, etc. I have to go there every month and pay a $35 copay to have my scripts renewed. Getting a referral to a pain management doctor in my state was impossible! I was met with some severe criticism, therefore, had to go out of state. I get my pain under control with the opiates prescribed allowing me to do a home exercise program and to walk. Please don’t make it more difficult for patients such as me to get the help I need to live a life of quality!

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