When actress Wynona Ryder was arrested for shoplifting several years ago at a Saks Fifth Avenue store, it wasn’t just the items she snatched that got everyone’s attention. It was the eight different opioids they found in her purse. “Two months prior to that, I broke my arm in two places, and the doctor … was giving me a lot of stuff like oxycodone and I was taking it at first to get through the pain,” she said. “And then there was this weird point when you don’t know if you are in pain but you’re still taking it.”

Ryder’s situation was an early pop culture signal of what many believe to be the worst public health drug crisis in decades. In March, the federal government published the first national standards for prescription painkillers. The Centers for Disease Control and Prevention (CDC) prepared the “Guideline for Prescribing Opioids for Chronic Pain” to help doctors make prudent and effective prescriptions.

“It has become increasingly clear that opioids carry substantial risk but only uncertain benefits – especially compared with other treatments for chronic pain,” wrote the Director of the CDC Thomas R. Frieden, M.D., MPH. He added, “Initiation of treatment with opioids is a momentous decision and should be undertaken only with full understanding by both the physician and the patient of the substantial risks involved.”

Equally important are recent comments by David Kessler, M.D., the former commissioner of the Food and Drug Administration (FDA): “The inappropriate promotion of drugs contributed significantly to this epidemic. Because drug companies took a small piece, a sliver of science and widely promoted it as not being addictive. That was false.”

The Scale of the Opioid Problem

Opiate painkillers lead all prescription drugs that result in overdose deaths. In fact, they kill more people in 17 states than do traffic accidents. Other alarming statistics from the CDC include:

• More than 165,000 people died from overdoses related to prescription opioids from 1999 to 2014
• An estimated 1 out of 5 patients with non-cancer pain or pain-related diagnoses are prescribed opioids
• Nearly 2 million Americans abused or were dependent on prescription opioids in 2014
• Since 1999, sales of prescription opioids in the U.S. have quadrupled

Meaningful Corrective Action

The CDC’s goal was to “provide recommendations for the prescribing of opioid pain medication for patients 18 and older in primary care settings. Recommendations focus on the use of opioids in treating chronic pain (pain lasting longer than 3 months or past the time of normal tissue healing) outside of active cancer treatment, palliative care, and end-of-life care.”

“By providing injured workers with comprehensive care management, we can help facilitate effective pain treatment and reduce the risk of opioid misuse and abuse,” said Steven Moskowitz, M.D., the senior medical director and supervisor of Paradigm Outcome’s complex pain program. “This leads to better outcomes for everyone involved.”

Among the reasons the guidelines are so important is that they were issued by a federal agency with the ability to promote the most effective practices. Beyond the authority of the source, Dr. Moskowitz called out five key features that should prove especially meaningful:

1. Non-opioid and non-pharmacological treatment is strongly recommended whenever possible.
2. Unlike other guidelines, the CDC does not open the door to rampant exceptions to the rule.
3. A careful assessment of individual risks and benefits is recommended for any doses ≥50 morphine milligram equivalents (MME)/day, and doses of 90 MME or higher should be avoided.
4. Clinicians should offer or arrange evidence-based treatment for patients with opioid-use disorder. (Unfortunately, most people with chronic pain don’t have opioid-use disorder, and if they do have it, they don’t acknowledge it and neither do their physicians.)
5. Both buprenorphine and methadone are identified as opioids and should be treated according to the risk they pose.

Biopsychosocial Solutions

At Paradigm, we recognize that opioid misuse is indeed a problem, one that has limited injured worker recovery and destroyed injured worker lives. We’re committed to ensuring that injured workers and our clients don’t fall victim. The CDC’s national guidelines are important first steps in addressing this growing problem.

However, while this drug-abusing group certainly needs our attention and strategies for prevention, there is an even larger population of overmedicated, injured workers at risk. These individuals require nuanced biopsychosocial intervention to lower the risk of misuse, resolve their pain complaints and return them to the lifestyle they enjoyed before their injury.

To learn more about Paradigm Outcomes and strategies for complex pain management, visit our website or follow us on Facebook, Twitter, and LinkedIn.