Thursday, 17 March 2016

IMA guidelines to restrict opioid prescribing

IMA guidelines to restrict opioid prescribing
  • The latest CDC guidelines endorsed by the Indian Medical Association (IMA) focus on chronic pain except for cancer and end-of-life care. Every day in US alone, over 40 people die from overdoses of opioid painkillers. In 2014, these deaths surpassed car accidents as the No. 1 cause of injury-related deaths.
  • Use of opioids such as Oxycodone and codeine is a leading cause of death in young adults. Among those individuals aged between 25 and 34 years, approximately one out of every eight deaths is related to opioid overdoses. Each year, 2 million people in US alone abuse or misuse the drugs.
  • Management of chronic pain is an art. For the vast majority of patients, the known, serious, and too-often fatal risks far outweigh the unproven and transient benefits
  • Chronic pain is defined as pain lasting more than three months. IMA recommends that doctors try other treatments, prescribing ibuprofen, referring a patient to a physical therapist or using injection treatments, before prescribing opioids.
  • IMA recommends limiting opioid prescriptions to people who have cancer, are receiving end-of-life or palliative care, or are suffering with serious illnesses. 
  • GPs write the vast majority of prescriptions for painkillers (about 50%).
  • IMA recommends that doctors prescribe opioids only after other therapies have failed and rely on the lowest possible doses.
  • IMA also suggests that short-term treatment, typically just 3 days, but sometimes 7 days, is far more preferable than long-term use. Patients who take opioids for extended periods are much more likely to become addicted. It is also a concern that more people may turn to heroin if opioids are harder to obtain
  • It is not true that Oxycodone is less addictive than other pain medications
  • Most placebo-controlled, randomized trials of opioids have lasted 6 weeks or less.
  • Doctors should also read and know how to manage addiction, including offering naloxone, a drug that reverses an overdose, or buprenorphine or methandone, both of which are used to treat addiction.
  • Oxycodone (poor man’s heroin) abuse is the most common. With its heroin-like effects, the prescription drug is not only popular for recreational use, but is also very dangerous. Oxycodone is extremely addictive and it doesn't take much to overdose on oxycodone and without immediate attention, it can lead to death. On a global scale, 100,000 people die from oxycodone abuse per year.
  • Combining lorazepam, alcohol and oxycodone can be deadly
  • Derived from opium poppy seeds, opioids primarily include prescription painkillers and heroin. Synthetic opioids include popular prescription drugs like Oxycontin (Oxycodone), Vicodin (Hydrocodone) and Duragesic (Fentanyl).
  • Combined with their highly-addictive nature, opioids are dangerous because a single large dose can cause severe respiratory depression and death.

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