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There is disagreement among doctors about the best way to prevent prescription painkiller abuse, sometimes even among physicians in the same hospital, according to The Plain Dealer. The Cleveland Clinic is among the institutions where colleagues disagree on the best approach to the problem.

Some doctors want stricter rules for prescribing opioids, arguing this could decrease addiction and drug abuse. Others are concerned tougher rules could penalize patients with long-term pain, particularly if the new rules call for opioid treatment only for those in severe pain, rather than moderate pain. This is a personal and subjective call, they say.

One Cleveland Clinic pain management specialist, Dr. Riad Laham, wrote a letter to the Food and Drug Administration (FDA) arguing that such a rule could lead patients to lie about their pain to meet higher thresholds, and could result in more illegal street sales of opioids.

Dr. Andrew Kolodny, who heads Physicians for Responsible Opioid Prescribing (PROP), says opioids are overprescribed. “We’re not trying to take these people’s opioids away from them, we’re trying to prevent new starts,” he told the newspaper. Dr. Edward Covington, Director of the Cleveland Clinic’s Neurological Center for Pain, supports a PROP petition to the FDA that states “an increasing body of medical literature suggests that long-term use of opioids may be neither safe nor effective for many patients, especially when prescribed in high doses.”

The group wants the FDA to change prescribing rules for opioids, so they are not indicated for moderate pain, to recommend a maximum daily dose, and to limit patients’ continuous use to a maximum of 90 days, the article notes.

The FDA, in a letter dated January 22, told PROP that it “has been unable to reach a decision on your petition because it raises significant issues requiring extensive review and analysis by agency officials.” The FDA did not say when it expects to make a decision.


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