Azar: Ease America's painkiller addiction

Dr. Frederick M. Azar

Nearly 2 million Americans are addicted to prescription painkillers. In an attempt to curb the abuse of these powerful medicines, the Drug Enforcement Agency recently tightened its rules governing opioids.

The DEA's new regulation specifically targets hydrocodone — an opioid found in many popular painkillers, including Vicodin, Lorcet, and Lortab. Most notably, patients will now have to visit a physician in person to obtain a new prescription.

New federal regulations alone, however, cannot solve America's painkiller addiction epidemic. Both patients and their healthcare providers have essential roles to play as well. Above all, what is needed is a fundamental shift in how pain is treated.

Patients must understand that pain is not always evil; it is a natural part of the body's healing process and does not require complete suppression. Indeed, the overuse of opioids can jeopardize the body's natural recovery. Research shows that carefully scaling back opioid use for surgery patients improves recoveries by reducing common opioid side effects, such as nausea, vomiting, lethargy and confusion.

Meanwhile, doctors need to embrace alternative pain management techniques. There are other, multidisciplinary approaches that are just as effective.

For instance, physicians have found success using local anesthetics to numb a particular injured area or surgical site, as opposed to dosing a patient with drugs that numb the whole body. This approach has proven so effective that in one study post-surgery patients receiving local anesthetics were more likely to complain about their hospital's Internet access than pain.

Another study looked at patients suffering broken ankles in the Netherlands. Their pain was treated with acetaminophen, better known by the brand-name Tylenol, and tramadol, an opioid drug with a lower risk of dependency. Dutch doctors found that this treatment plan did not sacrifice patient well-being as compared to use of stronger opioid medications. In the United States, such patients would typically receive hydrocodone or oxycodone, some of the most powerful opioids in the world that run a high risk of addiction. Yet, patients in both countries report equal levels of pain and equal satisfaction with their pain relief.

Clearly, there is room for improvement in the level of opioid use in the United States. Our country represents just 4.6 percent of the world population, and yet it consumes over 80 percent of the world's prescription opioids.

Caregivers need to incorporate these opioid alternatives into their pain management protocols. And they should stress to patients the importance of support from friends and family during the healing process.

For its part, law enforcement should commit additional resources to monitoring non-therapeutic prescriptions, while also avoiding any interruptions of legitimate opioid use.

The Drug Enforcement Agency's recent rules change occurred despite appeals from some in the medical community, including my organization, the American Academy of Orthopaedic Surgeons. Many physician groups worry that the new rules may complicate legitimate medical application of opioids. These reforms may also inconvenience patients filling clinically necessary prescriptions.

The dramatic increase in the rate of opioid abuse in the U.S. led to these federal policy changes. Millions of people are falling into the vicious cycle of addiction. Moving forward, regulators should consider further reforms, including requiring electronic prescriptions for all controlled substances.

All these efforts need to be complimented with a shift in thinking among patients and doctors. Powerful opioids, if misused, should be seen for what they are: dangerous. They are just one tool among many. Less risky but equally effective approaches to pain management ought to be embraced.

Dr. Frederick M. Azar is president of the American Academy of Orthopaedic Surgeons and team physician for the NBA's Memphis Grizzlies.