Before 2016, loose guidelines on prescribing opioids allowed chronic pain patients to have more access to life-changing opioid medications. Today, new guidelines, albeit more lax than before, have increased oversight into prescription opioids.

Rising stigma against opioid use disorder and addiction have also made it difficult for chronic pain patients to fill their prescriptions. The result is an increase in pain, suffering, and decreased quality of life for those who once found relief from a routine medication.

Opioid Use Vs Over the Counter Medicines

Chronic pain is one of the most difficult and complex conditions to treat. It is so pervasive, studies show that people with chronic pain suffer with pain for at least 5 years, if not longer. Living with chronic pain makes it extremely difficult to complete daily tasks. Something as simple as getting out of bed or putting on a shirt can seem impossible.

While there are other medications that are effective at treating pain, such as acetaminophen and NSAIDs like ibuprofen, these medications do little to help treat people with the most severe pain. Studies show that, while a combination of over-the-counter medicines have the same effect on pain as some opioids like morphine, other opioids like tramadol and oxycodone with acetaminophen provide more than triple the pain relief of over-the-counter medications and prescription NSAIDs.

The Risks of Using Opioids for Chronic Pain

The trade-off of using opioids for chronic pain relief can be significant, with opioids having a high risk of complications such as overdose and dependence. These issues are so severe and pervasive, the CDC published its 2016 opioid prescription guidelines, which emphasized the need to rapidly scale back on prescribing opioids to patients.

Some practices recommended by the CDC in this guideline included:

• Using Non-pharmacologic pain management first
• Provide justification for prescribing more than ≥90 morphine milligram equivalents (MME)/day
• Avoid prescribing more than a couple days worth of medication (usually 7 days)
• Taper or discontinue use if needed

While these guidelines were published by the CDC in an effort to combat the over-prescription and misuse of opioids, it had unintended consequences for chronic pain sufferers. Healthcare providers, insurance companies, pharmacies, and even pain management clinics all interpreted these guidelines as discouraging long-term opioid prescribing.

The resulting lack of availability of prescription opioids is speculated to have been a trigger for the rise in fentanyl and heroin overdose deaths, which continued to increase during the COVID-19 pandemic. In short, these 2016 guidelines did more harm than good for chronic pain and cancer patients, who once depended on opioids to simply function.

New Guidelines and Corrective Action

Rising overdose deaths and the outcry of chronic pain patients spurred the CDC to correct its guidelines in November 2022, more than 6 years after their initial opioid prescription guidelines were released. These new guidelines emphasized the need for patient-centered care and flexibility.

While it’s true that opioids can be incredibly dangerous when misused, it’s also true that they provided the only form of relief some patients knew. Suddenly stopping opioid medication can have dangerous effects, including withdrawal, increasing pain, lowered quality of life, and a negative impact on mental health.

These amended guidelines aimed to remediate and mitigate the effects of their original guidelines and the surrounding stigma of using opioids. However, some believe it’s simply too little too late. That’s because states have the power to heavily regulate opioid medications and prevent providers from prescribing them for pain treatment.

State laws can limit the daily maximum dosage prescribed and limit the amount of medication dispensed at once, among other limits. As of 2019, 39 states have imposed such regulations on chronic pain patients, with states, providers, and other carriers of opioid medications continuing to cite the original CDC guidelines for their heavy restrictions.

Preventing Opioid Use Disorder and Addiction

New guidelines and increasing awareness of the nature of opioid use disorder and addiction can all contribute to the de-stigmatization of prescription opioid use for chronic pain. Addiction is an incredibly complicated disorder, and not everyone who is prescribed an opioid will experience dependence. However, it’s worth exploring ways to help prevent opioid use disorder.

People who take prescription opioids for chronic pain can minimize their risk of addiction by doing the following:

• Always use your medication as prescribed
• Do not take more than the recommended dosage, even if experiencing breakthrough pain
• If you’re experiencing withdrawal symptoms or symptoms of dependence, speak to your physician to explore non-opioid options
• Never use illicit drugs or non-prescription opioids in place of your prescribed medication

Future For Patients With Limited Medication Options

Unfortunately, not everyone will have access to physicians who prescribe opioids or be near pharmacies that fill prescriptions. Traveling to pharmacies and providers who understand how to minimize risks of opioid use in your surrounding area might be the best option.

In addition, continue to explore non-pharmacological methods such as massage therapy, muscle relaxation, and cognitive-behavioral therapy when using your medication. Newer holistic treatments are becoming more and more studied and lauded for their effect on chronic pain. From yoga to changes in diet and lifestyle, biofeedback therapy, and more, there are a vast array of additional chronic pain treatments that can help chronic pain patients recover and improve their quality of life – with or without opioids.