The FDA is expected to tighten restrictions on painkillers containing hydrocodone, like Vicodin, following Friday’s vote by an advisory panel. Under these controls, only written (not faxed or called in) prescriptions from a doctor would be filled, no refills would be allowed, and nurse practitioners and physician assistants could not prescribe the drugs*. These same restrictions already apply to drugs containing oxycodone (including Oxycontin and Percocet). Reducing addiction to prescription painkillers is the goal of the recommendation, though experts debate whether this is an effective approach. Patient advocates argue such constraints will be an enormous burden to those who rely on these drugs for chronic pain.
Prescription drug addiction is not a trivial problem. One hundred people die every day in the US from a drug overdose and the CDC attributes most of those deaths to prescription painkillers. In 2010, about 12 million Americans reported using prescription painkillers recreationally in the previous year.
No one should have to live with the unrelenting misery of chronic pain. Because opioids can make the brain more sensitive to pain and make migraine more difficult to treat, I no longer advocate broadly for the use of opioids for headache or migraine management. In fact, the long-term efficacy and potential harmful effects of opioid use for any type of chronic pain are in question. If opioids aren’t the answer, then patients must have access to other effective therapies, drug or otherwise. Unfortunately, alternative solutions aren’t always available. Pain patients may have to pay the cost — financial as well as physical — of dragging themselves to the doctor each month for medication to manage their pain.
Is there a way to prevent drug abuse without increasing the suffering of people who live with horrible pain?
*States differ on how they implement these restrictions. Some allow doctors to write prescriptions to be filled at a future date. Some allow physician assistants and nurse practitioners to write prescriptions with the approval of a licensed physician.