Editor’s Desk

Opioid addiction

Peter Wehrwein
Editor

The federal government finally seems to stepping up its efforts to tame the opioid epidemic.

Today President Obama is scheduled to announce a number of initiatives, including a new rule that will allow doctors to prescribe buprenorphine, an opioid partial agonist and treatment drug for opioid addition, for up to 200 patients, double the current limit.

Last week, the FDA issued a draft guidance for developing generic versions of abuse-deterrent opioids. And a few days earlier, the agency slapped a new boxed warning on immediate-release opioids that resembles the warning on extended-release formulations.

The FDA actions came on the heels of the CDC issuing new opioid prescribing guidelines, which, among other things, advise clinicians to prescribe immediate-release opioids instead of long-acting ones when starting a patient on opioid therapy and to consider annual drug testing of patients taking opioids for chronic pain.

If opioids are falling out of favor, other kinds of painkillers might take their place. But there are problems there, too.

For example, a meta-analysis published in the Lancet last week cast doubt on the effectiveness of acetaminophen. The study — which included 74 randomized trials and more than 58,000 patients — concluded that acetaminophen has little, if any, effect on pain from hip and knee osteoarthritis.

Diclofenac at 150 mg per day emerged as the most effective of the medications included in the meta-analysis. But diclofenac increases the risk of having a cardiovascular event.

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