American Academy of Neurology Warns Against Opioid Painkillers. By Erik Derr. latinpost.com. September 30, 2014.After recent public protests over approval of hydrocodone and other narcotics by the U.S. Food and Drug Administration, the American Academy of Neurology is advising against using painkillers for general discomfort. In a position paper published in the Sept. 30 print issue of the medical journal Neurology, the 21,000-member professional group asserts the side effects of prescription narcotic opioids outweigh any benefits by taking the medication for chronic, non-cancer conditions such as headache, fibromyalgia and chronic low back pain.
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Aside from hydrocodone, opioid pain medications include morphine, codeine, oxycodone, methadone and fentanyl, or a combination of the drugs with acetaminophen.
"More than 100,000 people have died from prescription opioid use since policies changed in the late 1990s to allow much more liberal long-term use," Gary M. Franklin, a fellow with the AAN and research professor in the Department of Environmental & Occupational Health Sciences at the University of Washington School of Public Health in Seattle, said in a news release. "There have been more deaths from prescription opioids in the most vulnerable young to middle-aged groups than from firearms and car accidents. Doctors, states, institutions and patients need to work together to stop this epidemic."
Studies have shown that 50 percent of patients taking opioids for at least three months get hooked on the drugs and continue taking them years later.
A review of the available studies showed that while opioids may provide significant short-term pain relief, there is no substantial reason for taking the narcotics over longer periods of time, since the extended effects of the medications are negligible and there's serious risk of overdose, dependence or addiction.
The AAN recommends doctors consult with a pain management specialist if dosage exceeds 80 to 120 (morphine-equivalent dose) milligrams per day, particularly if pain and function have not substantially improved in patients. The group advises the following key points of consideration in order for doctors to prescribe opioids more safely and effectively:
- Create an opioid treatment agreement.
- Screen for current or past drug abuse.
- Screen for depression.
- Use random urine drug screenings.
- Do not prescribe medications such as sedative-hypnotics or benzodiazepines with opioids.
- Assess pain and function for tolerance and effectiveness.
- Track daily morphine equivalent dose using an online dosing calculator.
- Seek help if the morphine-equivalent dose reaches 80 to 120 milligrams and pain and function have not substantially improved.
- Use the state Prescription Drug Monitoring Program to monitor all prescription drugs the patient may be taking.
"More research and information regarding opioid effectiveness and management is needed, along with changes in state and federal laws and policy to ensure that patients are safer when prescribed these drugs," said Franklin.