States becoming stricter on use of opioids for back pain, other conditions

Oct 24 2011
Patients with back pain, neck pain and other chronic non-cancer conditions are complaining about stricter state regulations on how doctors prescribe opioids. The new laws are part of a growing trend of efforts to cut down on the number of accidental opioid-related deaths, according to American Medical News.

About 80 percent of Americans will experience back pain at some point in their lives. It is the leading neurological condition that afflicts Americans, second only to headaches, and is a major cause of reduced productivity and lost wages from time taken off of work.

The spinal cord that connects the brain to the rest of the body is protected by the vertebrae, the facet joints and the intervertebral discs that cushion the spaces in between the bones. Back pain is the result of injury, disease or age-related degeneration of any of these structures, as well as the surrounding muscles and ligaments.

Acute back pain is sudden and severe, and is usually caused by an injury. This type of condition should clear up within six weeks, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, a division of the National Institutes of Health. Chronic back pain lasts longer than three months, and may persist even after the original cause has been resolved.

Conservative approaches to chronic back pain may include opioid medications such as morphine, codeine and meperidine. They work by altering the brain's perception of pain. However, patients taking opioids have a risk for developing a tolerance to the medication, leading them to require stronger doses in order to experience previous levels of pain relief.

Between 1999 and 2007, the number of opioid-related deaths in the U.S. more than tripled, making up 36 percent of the 40,059 poisoning deaths in 2007, according to the Centers for Disease Control and Prevention. In an effort to reduce such incidents, several states are enacting new laws to regulate doctors' prescription practices, according to American Medical News.

In Washington state, the latest rules have new guidelines on patient evaluation, mandatory urine tests and a requirement to consult board-certified pain specialists before prescribing doses of morphine greater than 120 milligrams.

In Ohio, physicians working at pain clinics must take continuing medical education (CME) courses and be subject to random site inspections as a stipulation of being able to prescribe opioids. Similar laws exist in other states such as Florida, where CME classes are required for medical licenses.

Although the new rules can make it easier for doctors to assess whether opioids are working effectively for patients, they may also drive doctors who view the additional regulations as burdensome to stop prescribing the medicine altogether. Patient advocacy groups are complaining that those with chronic pain are beginning to have trouble finding doctors who will treat them with opioids.

"There are major problems in trying to solve this whole mortality and complications issue with addiction, diversion and otherwise," said Michael Schiesser, MD, an addiction-medicine specialist in Bellevue, Wash. "But there are a whole lot more people out there with pain, whether it's addressed by a doctor or not, than there are these complications. We're really throwing out the baby with the bathwater here."