EDITORIAL: Opioid consensus needed

York Dispatch

The medical community has found itself in a dilemma.

According to a story in Monday's York Dispatch, the Centers for Disease Control and Prevention was on track to finalize new prescribing guidelines for opioid painkillers in January.

Mind you, these are just guidelines and not binding on anyone. Still, they would be the strongest government effort yet to reverse the rise in fatal overdoses tied to highly addictive drugs such as OxyContin, Vicodin and Percocet. Under the proposed guidelines, doctors would prescribe the opioids only as a last resort after all other options were exhausted. The CDC also wants doctors to prescribe the smallest amount possible and to continue the use of the drugs only if patients show significant improvement.

Sounds simple enough. Limit the amount of opioids out there and you limit the possibility that people will get hooked on the powerful drugs, which often serve as a gateway to heroin use.

In government, however, nothing is ever simple.

If doctors limit the access to opioids, the folks who desperately need those drugs, cancer victims for example, may suffer through unnecessary and agonizing pain.

The critics of the guidelines argue the CDC went too far and that the proposals were written mostly behind closed doors. Lawsuits were threatened. Earlier this month, Food and Drug Administration officials called the guidelines "shortsighted," relying on "low-quality evidence." The FDA, however, may simply be trying to protect its turf, since that organization is formally assigned with advising physicians on medications and their use. The CDC, meanwhile, only rarely enters that arena.

Dr. Matt Howe, the medical director for the York City Health Bureau, said the CDC stirred a "hornet's nest" with its proposed guidelines, which he described as "well intended, but misguided."

York County Coroner Pam Gay, however, had a different view.

"(The proposed guidelines are) not trying to take (painkillers) away from people who really need it, but we really have a problem in this country ... and must be more responsible about how we're prescribing (these drugs). "

The fact that the pain medications rang up more than $9 billion in sales last year only adds another economic complication to the discussion.

So the longstanding debate rages on, and the new CDC guidelines likely won't be adopted anytime soon. The CDC has abandoned its January target date, instead opening the guidelines to public comment for 30 days. Those comments could lead to some changes in the guidelines.

In the meantime, people are in pain and need help, but the opioids that can alleviate their suffering are a problem unto themselves.

Gay said her office has confirmed about 79 non-heroin-related drug deaths this year in York County, and the majority of those deaths involved opioids in one way or another. Nationally, deaths linked to the misuse and abuse of prescription opioids climbed to 19,000 last year, the highest figure on record, according to the CDC.

The problem is real and getting worse.

Debate is normally a healthy thing, but the medical community needs to come to some sort of consensus soon. The CDC and the FDA need to provide a unified front on the subject and give doctors the best advice possible.

While the government debate rages on, people are in pain and dying from overdoses.

Something must be done, soon.

In this file photo, family and friends of heroin overdose victims take part in a rally on Continental Square in York to bring awareness to "Don't run, call 911," in November 2015. John A. Pavoncello photo.