New CDC Guidance on Prescribing Opioids for Pain
Posted over 1 year ago by Rick Ramirez in Education
The US Centers for Disease Control and Prevention (CDC) has releasedupdated and expanded recommendations for prescribing opioids for adults with acute and chronic pain not related to cancer, sickle cell disease, or palliative/end-of-life care.
The 2022 Clinical Practice Guideline provides guidance on determining whether to initiate opioids for pain; selecting opioids and determining opioid dosages; deciding duration of initial opioid prescription and conducting follow-up; and assessing risk and addressing potential harms of opioid use.
"Patients with pain should receive compassionate, safe, and effective pain care. We want clinicians and patients to have the information they need to weigh the benefits of different approaches to pain care, with the goal of helping people reduce their pain and improve their quality of life," Christopher M. Jones, PharmD, DrPH, acting director for the CDC's National Center for Injury Prevention and Control, said in a news release.
How to Taper Safely
The last guideline on the topic was released by CDC in 2016. Since then, new evidence has emerged regarding the benefits and risks of prescription opioids for acute and chronic pain, comparisons with nonopioid pain treatments, dosing strategies, opioid dose-dependent effects, risk mitigation strategies, and opioid tapering and discontinuation, the CDC says.
Key recommendations in the 100-page document include the following:
-
In determining whether or not to initiate opioids, nonopioid therapies are at least as effective as opioids for many common types of acute pain. Use of nondrug and nonopioid drug therapies should be maximized as appropriate, and opioid therapy should only be considered for acute pain if it is anticipated that benefits outweigh risks to the patient.
-
Before starting opioid therapy, providers should discuss with patients the realistic benefits and known risks of opioid therapy.
-
Before starting ongoing opioid therapy for patients with subacute pain lasting 1 to 3 months or chronic pain lasting more than 3 months, providers should work with patients to establish treatment goals for pain and function, and consideration should be given as to how opioid therapy will be discontinued if benefits do not outweigh risks.
-
Once opioids are started, the lowest effective dose of immediate-release opioids should be prescribed for no longer than needed for the expected duration of pain severe enough to require opioids.
-
Within 1 to 4 weeks of starting opioid therapy for subacute or chronic pain, providers should work with patients to evaluate and carefully weigh benefits and risks of continuing opioid therapy; care should be exercised when increasing, continuing, or reducing opioid dosage.
-
Before starting and periodically during ongoing opioid therapy, providers should evaluate risk for opioid-related harms and should work with patients to incorporate relevant strategies to mitigate risk, including offering naloxone and reviewing potential interactions with any other prescribed medications or substances used.
-
Abrupt discontinuation of opioids should be avoided, especially for patients receiving high doses.
-
For treating patients with opioid use disorder, treatment with evidence-based medications should be provided, or arrangements for such treatment should be made.
Jones emphasized that the guideline is "voluntary and meant to guide shared decision-making between a clinician and patient. It's not meant to be implemented as absolute limits of policy or practice by clinicians, health systems, insurance companies, governmental entities."
He also noted that the "current state of the overdose crisis, which is very much driven by illicit synthetic opioids, are not the aim of this guideline.
"The release of this guideline is really about advancing pain care and improving the lives of patients living with pain," he said.
"We know that at least 1 in 5 people in the country have chronic pain. It's one of the most common reasons why people present to their health care provider, and the goal here is to advance pain care, function, and quality of life for that patient population, while also reducing misuse, diversion and consequences of prescription opioid misuse," Jones added.
Morb Mortal Wkly Rep MMWR. Published online November 3, 2022. Full text