Narcotics abuse: an American dilemma

Prescription painkillers overdoses caused more than 15,500 U.S. deaths in 2009. The drugs responsible include hydrocodone, oxycodone, oxymorphone and methadone. Most of the four million methadone prescriptions that year were written by practitioners without pain-management training(1).

In Washington State, a 2010 law caps the dose of an opioid permitted without review by a pain specialist. D^r Ardith Doorenbos, RN, said the law was necessary but complicates the treatment of chronic pain in rural residents, due to a lack of such specialists.

Doorenbos obtained funding for Telepain, an initiative which helps rural practitioners meet the state's requirements. An interprofessional team – a physician, an anesthesiologist, a psychiatrist, specialists in addiction and in rehabilitation, and a nurse – reviews cases faxed from state-wide clinics and faxes back their recommendations. “If we want to avoid those deaths, we've got to have nursing at the table,” she said. “Telepain is all about training the practitioner in the community. What we need are pain champions.”

Approved in July 2012, the U.S. Food and Drug Administration’s (FDA) Risk Evaluation and Mitigation Strategy (REMS) for long-acting and extended-release opioids requires their manufacturers to offer free or low-cost continuing education for prescribers addressing risks and safe use.

When it comes to managing chronic non-cancer pain, several questions remain unanswered: Are opioids appropriate? And if so, will the REMS prevent their misuse or just make it more difficult for patients in pain to get effective medication?