By: Dra. Carolyn Rodríguez
MCS Pharmacy Executive Vice President
Living with pain is a reality that affects a large part of the population in the U.S. According
to the Centers for Disease Control and Prevention (CDC), it’s the leading cause of
disability in the nation. A report on opioids prescribed in the U.S. during emergency room
visits notes that up to 42% of these visits are related to pain. Although opioid
administration is an option for relieving moderate or severe pain, especially after surgery,
the risks of opioid drugs include depression, confusion, dizziness, falls and dependence.
According to data from the CDC website, the use of illicit drugs and prescription opioids
is claiming 250 lives a day in the U.S. Just this year, the CDC updated its guidelines for
prescribing opioids, seeking safer access to this type of treatment. These new guidelines
establish rules for doctors to prescribe opioids safely by assessing the risks and benefits,
while establishing the appropriate follow-up plan.
| Issue |
Some Recommendations |
|
Introduction or continuation
of opioid treatment for
chronic pain |
• Select non-pharmacological or non-opioid therapies to
treat chronic pain. Opioids are not the first line of
treatment for this type of pain. |
|
Opioid selection, dosage,
duration, follow-up and
discontinuation
|
• Select rapid-release opioids as therapy for acute pain,
and prescribe the lowest effective dose. Treatment
lasting three (3) days or less is usually sufficient.
• Carefully reassess the benefits and risks when
determining whether to increase the dose to ≥50
milligrams equivalent to morphine (MME)/day. Avoid
increasing the dose to ≥90 MME/day or justifying the
decision to titrate the dose to ≥90 MME/day.
|
|
Risk level and harm from
opioid use
|
• Using virtual tools (ex. PDMP), verify whether the
patient has high doses or prescriptions from other
providers.
• Avoid prescribing benzodiazepines and opioids
together.
• Coordinate treatment for opioid use disorder if
needed.
|
Although opioids are a treatment alternative, the reality is that a patient-centered
approach to care provides alternatives to help manage pain. An emergency room visit must
not open the door to a patient’s first-time exposure to a drug that can cause dependency
and be life-threatening if not used properly.
Some alternatives to opioids that can improve the quality of life for patients
with pain while decreasing their risk of dependence and reducing side effects
include acetaminophen and ibuprofen, physical therapy, exercise, therapeutic
massage, acupuncture, local injections, weight control and monitoring food
and alcohol consumption. Effective options also include mental health therapy and the
use of antidepressant drugs, as well as cognitive behavioral therapy to identify triggers and
manage pain.
According to 2019 data from Health Affairs, opioid abuse sends nearly half a million people
to emergency rooms in the U.S. annually. Faced with a scenario that represents estimated
hospital costs at $2 billion annually in the U.S., hospitals must understand their leading role
in the fight against opioids. In addition to addressing the emergency, these facilities have the
resources to proactively contribute to this public health issue. Therefore, it’s imperative for
them to be up to date regarding the guidelines, while providing continual training to staff
members regarding this issue. These facilities can also analyze cases and statistics related to
patients with chronic pain who visit their emergency rooms, to assess whether these
individuals are being cared for using the recommended approach.
In Puerto Rico, the situation is not that different, and according to the Health and Addiction
Services Administration (Spanish acronym ASSMCA), a total of 1,098 opioid overdoses
were reported between January 2019 and December 2021, with 1,018 lives saved, thanks
to the administration of naloxone. In order to address this public health problem, this
entity provides recovery-oriented services, as well as treatments and initiatives throughout
the year, and includes collecting the drugs at participating pharmacies. Online tools such as
PMP AWARE (Prescription Monitoring Program) support both doctors and hospitals to
review a patient’s prescription history and use of these types of drugs.
Insurers are also responsible for supporting these efforts and providing resources for
patients living with pain – especially for the population over the age of 65. In addition, as
part of MCS’s preventive approach, educational activities are provided to help patients
identify their pain triggers and learn how to manage them. Also, MCS Classicare members
can take advantage of comprehensive care with mental health support, patient education,
healthcare service providers, and exercise classes, as well as coverage that includes
alternative medicine such as chiropractor visits, massages, and alternative therapies. This is
all supported by the Drug Management Program (DMP), which is responsible for
identifying patients at risk for opioid use and integrating the doctors who prescribe them,
to provide effective and safe treatment that promotes patient well-being.
References:
-
“Conozca Sus Opciones.” Centers for Disease Control and Prevention, Centers for
Disease Control and Prevention,
https://www.cdc.gov/opioids/patients/es/options.html
- “Detener La Sobredosis.” Centers for Disease Control and Prevention, Centers for
Disease Control and Prevention, https://www.cdc.gov/opioids/patients/es/options.html
- “For Hospitals, a Blueprint for Fighting the Opioid Epidemic.” Health Affairs, https://www.healthaffairs.org/do/10.1377/forefront.20191217.727229
- “Guidelines for Prescribing Opioids for Chronic Pain Factsheet.” Centers for Disease
Control and Prevention, https://www.cdc.gov/drugoverdose/pdf/prescribing/Guidelines_Factsheet-a.pdf
- “MCS.” Programas De Bienestar: MCS Alivia,
https://mcs.com.pr/es/Paginas/bienestar/programas-bienestar/mcs-alivia.aspx
- “MCS.” Terapia De Medicamentos
- “Opioides.” Administración De Servicios De Salud Mental y Contra La Adicción,
https://assmca.pr.gov/Opioides/index.html
- “Opioids Prescribed at Discharge or Given During Emergency Department Visits
Among Adults in the United States, 2016.” National Center for Biotechnology
Information, U.S. National Library of Medicine,
https://pubmed.ncbi.nlm.nih.gov/
- “Opioids.” Centers for Disease Control and Prevention, Centers for Disease Control
and Prevention,
https://www.cdc.gov/opioids/healthcare-professionals/index.html
- “Process for the Development of the 2022 Clinical Practice Guideline for Prescribing
Opioids for Pain.” Centers for Disease Control and Prevention, Centers for Disease
Control and Prevention, 3 Nov. 2021,
https://www.cdc.gov/opioids/guideline-update/index.html
- “Sobredosis De Opioides.” World Health Organization, World Health Organization,
https://www.who.int/es/news-room/fact-sheets/detail/opioid-overdose
- Redacción. “Vigilante ASSMCA Ante El Uso De Opioides En Puerto Rico.” El Vocero
De Puerto Rico, 29 May 2022,
https://www.elvocero.com/gobierno/agencias/vigilante-assmca-ante-el-uso-de-opioides/
