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Are prescription pain killers getting safer?

Tighter rules make drugs like Percocet, Vicodin, and Oxycontin harder to abuse

Published: February 20, 2015 06:00 AM

Overdose deaths due to narcotic painkillers are finally on the decline, according to a recent report from the Centers for Disease Control and Prevention (CDC). Deaths due to prescription opioids, such as OxyContin, Percocet, and Vicodin, dropped 5 percent in 2012 (the most recent year for which a full analysis is available). That’s the first time in more than a decade that the death rate went down rather than up.

But there’s still plenty of room for improvement. The report finds that more than 16,000 Americans died after overdosing on a prescription opioid in 2012. “We’re going in the right direction,” says Deborah Dowell, M.D., who leads the prescription drug overdose health system at the CDC. “Obviously, we still have a long way to go.”

There are several hopeful signs that things may get better this year. The following changes, now all in the works, represent big wins for consumer safety and public health.

New drugs that deter abuse

Long-acting, or extended-release, opioids can be convenient for people who need around-the-clock pain relief. But their potency makes them a target for people who abuse the medication by crushing it to snort or inject the entire dose all at once. Drug manufacturers have taken steps to address that problem.

Embeda (morphine and naltrexone), Hysingla ER ( hydrocodone), Targiniq ER (oxycodone and naloxone), and a new version of Zohydro ER (hydrocodone) are all formulated to discourage people from abusing the drugs to get high. The original version of Zohydro ER, approved in late 2013, did not have that protection—an omission that drew widespread criticism from consumer groups, including Consumer Reports, public health organizations, and law enforcement agencies.

The new pills are harder to chew, snort, or dissolve. For example, updated Zohydro ER capsules and Hysingla ER tablets form a thick goo when dissolved in a liquid that would be hard to inject. Hysingla ER tablets are also difficult to crush into a snortable powder. And crushing a tablet of Targiniq ER or an Embeda capsule will release another drug that counteracts the euphoric effects of the opioid. Those strategies do appear to help: research suggests that illicit use of the long-acting opioid  OxyContin (oxycodone) dropped after it was reformulated.

But the drugs still carry significant risks, cautions Andrew Kolodny, M.D., chief medical officer at Phoenix House, a national network of addiction treatment centers, and co-founder of the nonprofit organization Physicians for Responsible Opioid Prescribing. “Most overdose deaths are in people who swallowed pills, not in those who snorted or injected the drug,” says Kolodny. “And these new drugs are not any less addictive or any less likely to cause serious side effects than conventional opioids.”

Tighter restrictions

Vicodin and other narcotic painkillers that combine the opioid hydrocodone with acetaminophen (the active ingredient in Tylenol) are the most prescribed drugs in the U.S. And, until recently, the drugs were easier to get than other narcotic painkillers. But as of late last year, the Drug Enforcement Agency reclassified hydrocodone-combination products as Schedule II controlled substances like other opioids. Those tighter restrictions mean, among other things, that doctors typically can’t phone in a prescription for Vicodin or similar drugs and that patients can’t get automatic refills. (Read more about the new drug rules.)

That should discourage doctors from prescribing the drugs when safer alternative treatments—an over-the-counter pain reliever or physical therapy, for example—might work, too. And patients who do take the drugs long term will benefit from closer monitoring.

Why Vicodin and other prescription painkillers are now harder to get.

Clearer guidelines

The best way to make a dent in the opioid epidemic is to convince doctors to stop prescribing the drugs so often. Guidance from the FDA and a major medical association should help.

In addition, the American Academy of Neurology (AAN) issued a groundbreaking set of guidelines in September 2104. The professional association for neurologists, doctors who frequently treat pain patients, officially warned its physicians about prescribing opioids for many types of chronic pain such as back pain, frequent headaches, or fibromyalgia, stating that the risk of death, overdose, addiction or other serious side effects outweighed any potential benefit.

That message differs from what many doctors were taught over the last 15 years, says Gary Franklin, M.D., research professor of environmental and occupational health sciences medicine at the University of Washington in Seattle, who wrote the report. “It turns out that the evidence that the drugs provide meaningful improvements in pain and function for people with chronic pain is very low, while the evidence of the harm is very high,” Franklin says.

Doctors are beginning to get the message, according to a study published online on Dec. 8, 2014, in JAMA Internal Medicine. In a nationally representative survey of 420 primary care and internal medicine physicians, 85 percent said that opioids were overused in clinical practice; nearly half reported being less likely to prescribe the drugs than they were a year ago. 

—Teresa Carr

Editor's Note:

This article and related materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).



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