The American Medical Association (AMA), the nation’s largest medical society, recently recommended at its annual meeting that pain be removed as a “5th Vital Sign” in professional medical standards. AMA President, Andrew Gurman, MD, said that physicians played a key role in starting the so-called “opioid epidemic” by over prescribing pain medications, and now must do their part to end it. Pain was first recognized as the 5th Vital Sign in 1996, giving pain equal status with temperature, respiratory rate, heart rate and blood pressure. According to data from the Centers for Disease Control and Prevention (CDC), the drug overdose death rate from opioids increased by 200 percent between the years 2000 and 2014. I recently spoke to a leading addiction psychiatrist who told me that, in his opinion, the leading cause of opioid addiction can be associated with adding pain as the 5th Vital Sign in the 1990’s. As a result, he indicated, opioids began to be over-prescribed. In my experience in working with healthcare professionals, many heroin users started with prescription opioids. This past March, the CDC published new guidelines for prescribing opioids for chronic pain. These guidelines provide recommendations for primary care physicians who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end of life care. The guidelines address when to initiate or continue opioids for chronic pain, opiate selection, dosage, duration, follow-up, and discontinuation; and assessing risk and addressing harms of opioid use. In a recent blog, I noted that the Pennsylvania Board of Pharmacy and the Pennsylvania Board of Medicine recently approved new guidelines for distributing and prescribing opioids. The CDC Guideline for Prescribing Opioids for Chronic Pain – United States, 2016, is an article well worth reading and can be viewed at www.cdc.gov/drugoverdose/prescribing/guideline.html
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