Faced with the growing crisis of opioid addiction, the Food and Drug Administration asked makers of those medications to cut back on the amount they produced.
Now, major medical centers like the University of Virginia are faced with a shortage, unable to prescribe those drugs for all of the patients in pain. But UVA has come up with alternatives and made some surprising discoveries in the process.
Pain is a complex problem that often has multiple causes, so doctors at the University of Virginia often prescribe several different drugs – like Neurontin, a prescription painkiller, and over-the-counter drugs like Tylenol and Aleve.
"Research has shown that different medications used together can actually sometimes provide better pain relief than just opioids alone," says Dr. Gabrielle Marzani, "and it also turns out that IV pain medications may not be as effective as oral medications and patches."
Marzani adds these combinations can be more effective than opioids like morphine, oxycodone or fentanyl. The hospital has also started giving pain medications during surgery. "One of the things that we realized is that it’s important to get ahead of pain—that once pain takes over, it’s hard to keep up with it, and so you want to be as proactive as you can."
These changes reduced reliance on opioids, and in general patients complained less about pain. "We found that the average amount of opioids given for surgery declined by 37% between March 2011 and November 2015, and pain scores improved," according to Marzani.
For some patients, Marzani says, opioids are still the best choice, and those patients will get them. The FDA has revised the limits it imposed on manufacturers, but the shortage of opioids is expected to continue into 2019.