As the Director of the National Institute on Drug Abuse, Dr. Nora Volkow believes that raising awareness of the role of abuse-deterrent painkillers in the medical community is essential in the fight against the national opioid epidemic. Although not enough opioid medications that are currently available have abuse-deterrent formulations, the ones that do are not being prescribed as much as they should be.
In both her blog on the NIDA website and in a recent speech at the annual meeting of the American Psychiatric Association in Atlanta, Volkow emphasized the importance of raising physician awareness in order to help make abuse-deterrent painkillers more readily available.
Rather than pay for the more expensive abuse-deterrent formulations, insurance companies tend to recommend generic versions of traditional painkillers like Vicodin and hydrocodone to keep their costs down. Such prescriptions can be particularly dangerous in cases of chronic pain, since opioids have been shown to be an ineffective and even detrimental treatment for long-term chronic pain.
In her blog, Dr. Volkow underscores the latest research. “Recent studies are shedding new light on why using opioids to kill pain in the short term can have the paradoxical effect of actually intensifying and prolonging pain—an effect known as opioid-induced hyperalgesia,” she wrote. “For example, a recent study using a rat model of chronic nerve pain found that morphine significantly enhanced sensitivity to pain following injury and prolonged the pain of the injury well beyond the point at which the tissues had healed.”
If patients with chronic pain are going to be given opioids, why shouldn’t the abuse-deterrent formulations be the primary option used by clinicians? Dr. Volkow highlights the letter sent out by the U.S. Surgeon General, Dr. Vivek Murthy, to 2.3 million prescribers in the U.S. that called for both greater physician education about opioids and better screening mechanisms of potential patients. Volkow goes on to admit there have been mistakes in the past that are only now being addressed.
“The increased aggressiveness in treating moderate acute and chronic forms of pain using opioids during the 1990s, abetted by heavy marketing of these drugs, will undoubtedly go down in history as another of those failed strategies, whose reversal we are now seeing in revised pain management guidelines such as those released by the CDC this past March,” she wrote.
Volkow emphasizes the importance of physicians being able to distinguish between opioid dependence and opioid addiction. “The potential dangers of restricting opioid medications on which patients are physically dependent could be devastating in the current drug landscape, where counterfeit pain pills made with the very potent opioid medication fentanyl are causing overdoses and claiming many lives,” she wrote.
Ultimately, Volkow believes that greater awareness and application of the latest technologies is essential, writing, “Safe and effective pain management needs to be a top priority for researchers and for the health care system.”
