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CDC Proposes New, More Flexible Guidelines for Opioid Prescribing
The Centers for Disease Control and Prevention (CDC) this week proposed new, more flexible opioid prescribing guidelines, an update to recommendations first published in 2016.
Designed for clinicians providing pain care, including those who prescribe opioids for patients with acute, subacute, or chronic pain, the newly proposed guidelines are “intended to be flexible to enable person-centered decision-making, taking into account an individual’s expected health outcomes and well-being,” according to the document. The guidelines are not intended for sickle cell disease-related pain management, cancer pain treatment, palliative care, or end-of-life care.
>> READ the CDC Clinical Practice Guideline for Prescribing Opioids—United States, 2022
The new guidelines include the following recommendations:
- Clinicians should discuss with patients the known risks and realistic benefits of opioid therapy, establish treatment goals for pain and function, and consider how opioid therapy will be discontinued if benefits do not outweigh risks.
- Clinicians should prescribe the lowest effective dosage of immediate-release opioids for no longer than needed for the expected duration of pain requiring opioids.
- Clinicians should work with patients to weigh the risks and benefits of continuing opioid therapy and use caution when increasing, continuing, reducing dosage.
- Clinicians should incorporate strategies to mitigate opioid-related risks, including offering naloxone when factors that increase the risk of opioid overdose are present, as well as reviewing potentially dangerous drug interactions.
As in 2016, the 2022 guidance continues to recommend that clinicians first consider non-opioid interventions to treat pain, such as nonsteroidal anti-inflammatory drugs (NSAIDs), as well as acupuncture, massage therapy, and physical therapy. The most notable way in which the new guidelines differ from the 2016 edition is that they no longer include specific guidance around amounts and durations for opioid prescribing.
In a statement emailed to Addiction Professional, Christopher Jones, acting director of the CDC’s National Center for Injury Prevention and Control, said the update incorporates knowledge and data on the benefits and risks of opioids and non-opioid pain treatments accumulated since the publishing of the original guidelines in 2016.
“In addition, we heard directly from patients, caregivers, and clinicians about their experiences with pain care and the challenges they have faced when recommendations such as dosage and duration limits are misapplied as rigid, inflexible standards of care,” Jones wrote. “Thus, our proposed draft recommendations were crafted to guide care based on the latest science while also remaining flexible to enable individualized, patient-centered care and to mitigate risk for misapplication.”
Alta DeRoo, MD, Hazelden Betty Ford Foundation chief medical officer, told Addiction Professional that the organization supported the 2016 guidelines and believed they afforded the flexibility needed to provide responsible, person-centered treatment. DeRoo noted, however, that many providers lack experience addressing substance use disorders with patients and struggle with navigating the complex issues of pain and addiction.
“While we don’t yet have a formal organizational position on the proposal, what I like about the new guidelines is that they are more explicit in describing non-opioid and multi-modal alternatives for pain and recommending other more person-centered interventions when signs of addiction appear,” DeRoo said in a statement emailed to Addiction Professional. “For any guidelines to be effectively applied, though, we need required education on addiction and pain for medical, nursing, physician assistant, and pharmacy students. That’s the critical missing piece.”
Andrew Kolodny, founder of Physicians for Responsible Opioid Prescribing and medical director for the Opioid Policy Research Collaborative at Brandeis University, was more skeptical of the proposed changes. Kolodny told the Washington Post that the opioid prescribing limits published in 2016 were “necessary and helpful” and that the decision to remove the prescribing limits is “not congruent with the evidence base that the guideline is relying on.”
Kolodny added that he believes opposition to prescribing limits “was orchestrated by drug companies that saw the attempt to curb opioid prescribing — especially of high-dose pills — as a threat to their profit margins.”
The updated Clinical Practice Guideline for Prescribing Opioids is now available for public comment through April 11. The CDC will then review public feedback before issuing a final version of the new guidance, a process that is expected to be completed by the end of 2022.
“We want to hear many voices from the public, including people living with pain and the health care providers who help their patients manage pain,” Jones said in a CDC news release. “The ultimate goal of this clinical practice guideline is to help people set and achieve their personal goals to reduce their pain and improve their function and quality of life. Getting feedback from the public is essential to achieving this goal.”
Editor's note: This story was updated on February 15, 2022, to include comments sent to Addiction Professional by Jones after the initial version of the article published.
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