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FDA acts to fight opioid overdose “epidemic”

methadoneiiDrug manufactures that market opioid painkiller medications will be required to train U.S. doctors, nurses and other health care professionals in the ways of safe use of the drugs, which have caused an epidemic of overdose deaths according to the Center for Disease Control (CDC).

The FDA introduced new safety measures for extended-release and long-acting opioid medications, such as oxycodone, hydrocodone, and methadone.  It comes in the form of a mandated blueprint on best practices measures directed at upwards of 20 companies that manufacture opioid analgesics, including how best to educate physicians who prescribe the medications.

New safety measures come from the FDA after the CDC published myriad striking statistics regarding drastically rising opioid overdose deaths.

The Federal requirement handed down from the FDA comes in the wake of a failed U.S. Congressional bill that went to vote several weeks ago.

“Although many Americans don’t realize it, prescription drug abuse is our swiftest growing drug problem. Many of those abuses involve opioids,” said Dr. Margaret Hamburg, commissioner of the Food and Drug Administration. “In 2008, nearly 15,000 Americans died where opioids were involved. In 2009, that number went up to 16,000.”


Opioids and Alternatives according to Dr. Torregiani

Dr. Seth Torregiani wrote a somewhat useful essay today about the state of opioid treatments in the medical marketplace and their viable alternatives.  He argues that while pain pills have a place in treating chronic pain, their usage has ballooned, screening other treatments that could be even more effective.

The original purpose of opioid medicines was for the treatment of pain related to cancer, or for the short-term treatment of moderate to severe pain from injury or following a medical procedure. They have since become the “go-to” medication for pain of all kinds, including chronic pain.

In my opinion, opioids, while they may have a role in chronic pain treatment and may be necessary at times, are not a great choice for the long-term treatment of pain.

…I think it has become incumbent upon the medical community, patients and their advocates as well as insurers and the government to seriously rethink the approach we have adopted as a society to the treatment of pain.



vicoOpioids have become the most prescribed class of drugs in the U.S. despite being potentially dangerous and very easily abused.  Recent studies have shed new light on the dangerous qualities of these drugs.

However, it’s one thing to claim what we all know to be the case—that the potential for overdose and abuse has skyrocketed—but it’s quite another to claim there are treatments out there that are as effective as opioids.  I remain skeptical, especially for cases involving chronic neuropathic pain.  Dr. Torregiani lays out the “wide variety of techniques and therapies that are now available”:

  • “Don’t take a percocet when acetimenophen (Tylenol) will do.”  Tylenol and NSAIDs (non-steroidal anti-inflammatory drugs) like Advil and Aspirin work very well with lower doses of opioid drugs and can reduce the need for higher or more frequent doses of opioids, he argues.  Do people really have opioids stashed away in the medicine cabinet reserved for headaches and minor aches and pain?  I find this bit of advice useless, and somewhat irrational.
  • “Don’t be stoic.”  Really?  Dr. Torregiani encourages patients to not “tough it out” and to always have their pain meds in their system.  I find this to be a useless point.  Usually people suffering from chronic pain want nothing more than to have relief, right?
  • “Honesty is the best policy.”  He makes the superfluous argument that people suffering from chronic pain shouldn’t see the complete eradication of pain as an ultimate goal.  I agree, but would like to add that after many years of suffering from chronic pain, most people wouldn’t be so delusional. “…[A] long-term strategy to manage pain, one that involves the patient, family and friends, employers as well as caregivers, is often the best approach, if a complete cure is unlikely.”  This just seems obvious to me, and unhelpful.
  • “Consider bodywork.”  Now this is some useful advice, and actually relates to the topic of alternative treatment that he originally set out to write about.  The idea is that chronic pain, whether it’s musculoskeletal related or neuropathic, causes additional somatic symptoms such as trigger points and muscle spasms that can be alleviated with some types of manual bodywork.  He specifically cites massage, myofascial release (vigorous massage), Rolfing, chiropractic manipulation, osteopathic manipulation, craniosacral therapy.
  • “Keep moving.”  This is also good advice.  Research suggests that activity is good for chronic pain.  Exercise increases endorphin release, improves blood flow, decreases muscle tension, improves moods, etc.. “I regularly advise my patients to keep moving — whether walking, tai chi, yoga, gardening, stretching.”

Overall, I found Dr. Torregiani’s advice to be well intentioned and out of touch.  I guess perhaps I could be the one who’s out of touch, but I’d be willing to bet that he’s never suffered from chronic pain, nor spent more than a few minutes at a time with his patients.  I think this is an all too common problem in the medical profession based on personal experience as well as a reading of How Doctors Think by Dr. Jerome Groopman.  This book is excellent and makes the case that communication needs to be restored between doctors and their patients in order to optimize care.  Any way, what do you folks think of Dr. Torrengiani’s column?  Could I have overlooked something?