59 msfocusmagazine.org In the late 1990s, physicians began to increasingly prescribe opioid medications to treat patients experiencing noncancer-related, chronic pain, including MS pain syndromes. This increased use of opioid products has led to widespread misuse of both prescription and illicit opioid products. From the years 1999 to 2014, the sales of prescription opioid products increased four times in the U.S.; however; the amount of pain reported by patients did not change. During the same time period, dosages of prescribed opioid products tripled. According to Dr. Ben W. Thrower, director of the MS Institute at the Shepherd Center in Atlanta, “Misconceptions about the safety of opioid products were primarily responsible for the surge in prescribing that started occurring in the 1990s.” Thrower went on to explain that one of the consequences of this overprescribing was increased demand for illicit opioids, specifically heroin, as many patients transitioned to using this more accessible and cheaper, street-version opioid. Opiod Epidemic Many refer to the current opioid situation today as the “opioid epidemic.” The opioid epidemic is so serious that last year the U.S. Department of Health and Human Services declared it a public health emergency. The opioid epidemic has caused many opioid- related deaths each year. In fact, the Centers for Disease Control and Prevention estimates that nearly 70 percent of drug overdose deaths involve opioid medications. From 1999 to 2016, opioid-drug overdose deaths increased five times. The CDC estimates that 115 people die each day from an opioid overdose. Centers for Disease Control and Prevention Guidelines for Opioids In April of 2016, the Centers for Disease Control and Prevention published updated guidelines in the Journal of the American Medical Association regarding the use of opi- oid medications. While these guidelines were not specific to MS pain syndromes, they are still applicable. Thrower explained that “it is common for patients with multiple sclerosis to suffer from chronic pain conditions that require treatment with medications” and that these chronic pain conditions may or may not be related to multiple sclerosis. While the guidelines are directed to health-care providers, Thrower suggests that patients talk with their physicians about them also. According to the guidelines: • Opioid medications should not be considered first-line treatments for pain. Nonpharma- cological treatments (e.g., physical therapy Opioid Epidemic – What it Means for Patients with MS By Ellen Whipple, Pharm.D. RX Update