The nation's top public health official on Tuesday sharply criticized the widespread treatment of aches and pains with narcotics, saying that doctors are prescribing such drugs too soon, too often and for too long — putting patients at risk of addiction and overdose.
Dr. Tom Frieden, director of the U.S. Centers for Disease Control and Prevention, said that doctors are relying on these powerful drugs to treat chronic pain when physical therapy, exercise and other remedies would be safer and in many cases more effective.
"These are dangerous medications, and they should be reserved for situations like severe cancer pain," Frieden said in his most forceful statement yet on the use of narcotic painkillers. "In many other situations, the risks far outweigh the benefits. Prescribing an opiate may be condemning a patient to lifelong addiction and life-threatening complications."
His comments come as the U.S. Food and Drug Administration considers new controls on the way narcotic painkillers can be prescribed and promoted. Earlier this year, a top Drug Enforcement Administration official publicly supported stricter limits on OxyContin, Vicodin and similar medications to "safeguard the American public."
At the same time, there is a growing awareness among law enforcement officials and public health experts that physicians' prescriptions play a significant role in fueling addiction and overdoses.
A Los Angeles Times analysis of more than 3,700 overdose deaths in Southern California from 2006 through 2011 found that nearly half involved at least one drug prescribed by a doctor. The majority of the deaths involved painkillers, often combined with other narcotics or alcohol. Those who died often began taking painkillers as the result of injuries and became addicted, according to autopsy reports and interviews with friends and family members of the deceased.
Drug overdose is one of the few causes of death in the United States that is worsening, eclipsing fatal traffic accidents in 2009. The CDC put the spotlight on the problem in 2011, declaring the surge in deaths an epidemic, and it has been escalating its efforts to reduce the toll ever since.
Outside of cancer wards and hospices, doctors traditionally avoided using narcotics for pain out of fear of addiction. But nearly two decades ago, fears of addiction began to subside amid a movement to alleviate suffering among people with non-cancer pain. New painkillers came on the market that were initially thought to be less prone to abuse. The use of narcotics was broadly expanded to such things as toothaches and arthritis.
"When I went to medical school, the one thing they told me about pain was if you give a patient in pain an opiate painkiller, they will not become addicted. And that was completely wrong," Frieden said.
During a conference call with reporters, Frieden presented the latest CDC findings: Fatal prescription painkiller overdoses among women have increased 400% since 1999 and are rapidly closing the drug death gender gap.
About 15,300 women died from overdoses of all kinds in 2010, more than from car accidents or cervical cancer, according to the CDC.
Overdose deaths rose most rapidly among middle-aged women who, previous research has shown, are more likely to suffer from chronic pain and to be prescribed painkillers.
"Mothers, wives, sisters and daughters are dying at rates that we have never seen before," Frieden said. "These are really troubling numbers."
Doctors, he said, need to more carefully weigh the risks of addiction and overdoses against the severity of their patients' pain. They also must consider other complications, such as a history of substance abuse. Frieden reiterated the CDC recommendation that doctors check prescription databases to ensure that their patients are not "doctor shoppers."
Frieden said there were bright spots in combating the epidemic. Washington state, he said, adopted guidelines beginning in 2007 for prescribing painkillers, leading to a decline in overdose deaths.
"There are important steps that need to be taken at many different levels, and the CDC is here to support those efforts," Frieden said.
The CDC does not set drug policy. But its research and recommendations influence the FDA, law enforcement agencies, doctors and local public health efforts.
Dr. Andrew Kolodny, a New York addiction doctor leading the bid to put curbs on narcotic painkillers, said Frieden's remarks "will go a long way" in helping persuade the FDA to take action.
"But I wonder how many more people will have to die or become addicted before they finally listen," Kolodny said.
Because the issue is pending before the FDA, a spokesman said the agency could not comment.
Dr. Lynn Webster, president of the American Academy of Pain Medicine, agreed with Frieden that only a small portion of patients need narcotic painkillers. But those who do "should not be abandoned," Webster said.
"We need safer and more effective therapies than opioids," he said. "But until these are developed, we must use the medications available to help those who cannot live without pain relief."
lisa.girion@latimes.com
scott.glover@latimes.com
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