…at a minimum, deeper discussion of what physicians are prescribing is warranted en will often tell you there is little more painful than childbirth. (Yet) the ONLY physicians who have NOT pressured me to take Vicodin are obstetricians. In other words, this method of pushing the drug is endemic and pervades all other areas of practice, whether for adults or children. Perhaps the medical community as a whole could learn from obstetricians’ methods of discussing pain management with patients. “Last, please know that as the wife of a physician, I am often asked why physicians ‘push’ addictive narcotics. Patients (and mothers) ask me if physicians get kickbacks from pharmaceuticals. I tell them no, but you can see the perception people are developing of the medical community. It is very sad.” Note: While the Board’s Guidelines are intended to provide physicians with guidance on prescribing controlled substances in the long- term treatment of chronic pain, they also address acute pain. Specifically, they state, “[o] pioid medications should only be used for treatment of acute pain when the severity of the pain warrants that choice and after determining that other non-opioid pain medications or therapies likely will not provide adequate pain relief. When opioid medications are prescribed for treatment of acute pain, the number dispensed should be for a short duration and no more than the number of doses needed based on the usual duration of pain severe enough to require opioids for that condition.” The Board encourages physicians to use these Guidelines when prescribing controlled substances and to follow the standard of practice when prescribing controlled substances that are highly addictive and have a tendency for abuse.
For information about free CMEs that tackle opioid prescribing, SAMHSA offers the following online: http://www.opioidprescribing. com/overview https://www.scopeofpain.com/ 16 | THE BULLETIN | MAY / JUNE 2016
Opioid Pain Medicines FDA Warning The U.S. Food and Drug Administration (FDA) is warning about several safety issues with the entire class of opioid pain medicines. These safety risks are potentially harmful interactions with numerous other medications, problems with the adrenal glands, and decreased sex hormone levels. The FDA is requiring changes to the labels of all opioid drugs to warn about these risks. • Opioids can interact with antidepressants and migraine medicines to cause a serious central nervous system reaction called serotonin syndrome, in which high levels of the chemical serotonin build up in the brain and cause toxicity (see list of Serotonergic Medicines) http://www.fda.gov/drugs/drugsafety/ucm489676.htm. • Taking opioids may lead to a rare but serious condition in which the adrenal glands do not produce adequate amounts of the hormone cortisol. Cortisol helps the body respond to stress. • Long-term use of opioids may be associated with decreased sex hormone levels and symptoms such as reduced interest in sex, impotence, or infertility. Patients and health care professionals are urged to report side effects involving opioids or other medicines to the FDA MedWatch program: www. fda.gov/medwatch, using the information in the “Contact FDA” box at the bottom of the page. (from the FDA website)