The Centers for Disease Control and Prevention (CDC) reports that from 1999 to 2017, nearly 400,000 people died from opioid addiction, including prescription and illicit opioids.

Now, a leading opioid expert is calling on doctors to use caution when prescribing the powerful medicines.

“The epidemic started in 1996, and it’s gotten steadily worse every year,” says Dr. Andrew Kolodny, co-director of Opioid Policy Research at Brandeis University and director and co-founder of Physicians for Responsible Opioid Prescribing (PROP).

He says there are three types of opioid-addicted Americans: 1) an older group, mostly comprised of black and Latino men, who are survivors of the 1970s heroin epidemic; 2) a young group, almost entirely white, that got addicted to opioid pills and then switched to heroin; and 3) an older group, mostly white and addicted to pills, that didn’t switch to heroin.

Aggressive prescribing

“It’s really important for doctors to prescribe cautiously so we stop getting people addicted,” according to Dr. Kolodny, who says the most commonly prescribed opioid drugs are hydrocodone and oxycodone, as well as cough syrups, Vicodin and Percocet, among others.

“Responsible prescribing means don’t give an opioid unless you absolutely have to, and if you have to give an opioid, give the lowest dose possible for the shortest period possible.”

He’s been working the opioid crisis for more than 15 years, and says pharmaceutical companies, hospitals and professional societies encouraged providers to be very aggressive in treating patients’ pain with opioids. Doctors were told the pills weren’t addictive.

Responsible Rx’s

Dr. Kolodny says even though prescription opioids are “highly addictive and very dangerous,” they’re important medicines, especially for treating pain at the end of life or after major surgery or a serious accident.

The problem is that the bulk of the prescribing in the U.S. is for conditions where opioids are more likely to “harm the patient than help the patient,” he says.

For example, dentists often prescribe opioids for a patient who has had his or her wisdom teeth removed. Instead, Advil taken together with Tylenol has been shown to effectively treat wisdom-teeth removal pain and inflammation. 

Other conditions including lower back pain, fibromyalgia and chronic headache are often treated with high doses of opioids. But doctors are slowly realizing opioids shouldn’t be prescribed to manage these moderately painful conditions.

“Responsible prescribing means don’t give an opioid unless you absolutely have to, and if you have to give an opioid, give the lowest dose possible for the shortest period possible,” says Dr. Kolodny.