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CDC releases draft of opioid prescribing guideline

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The U.S. Centers for Disease Control and Prevention has released a draft of its hotly anticipated guideline for prescribing opioids for chronic pain.

The proposed 2016 guideline for prescribing opioids for chronic pain is intended to reduce the risks associated with long-term opioid use, improve the safety and effectiveness of treatment, and enhance communication between health care providers and patients, according to the draft released Monday. The CDC notes that it's a voluntary guideline, not a federal regulation.

In addition to being dubbed a national epidemic, opioid use and misuse is a top concern in the workers compensation industry. While organizations like the American College of Occupational and Environmental Medicine and states like Washington already offer opioid prescribing guidelines, the CDC's recommendations could become the new standard for treating injured workers, sources have said.

Based on the “best available evidence that was interpreted and informed by expert opinion,” the CDC's proposed guideline recommends when to initiate or continue opioids for chronic pain; how to select the drugs, dosage and duration; and how to assess the risks of use.

Regarding when to initiate or continue opioids, the guideline states that nonpharmacologic and nonopioid pharmacologic therapy are preferred treatments for chronic pain, and that health care providers should only consider opioid therapy “if expected benefits for both pain and function are anticipated to outweigh risks to the patient.”

Before starting opioid therapy, the guideline suggests establishing treatment goals with patients, and discussing known risks and realistic benefits.

When selecting opioids, health care providers should first prescribe immediate-release opioids instead of extended-release/long-acting opioids to prevent manipulation, such as the injection of oral opioids, according to the guideline.

In addition to recommending that providers start patients on the lowest effective dosage, the guideline notes that a duration of three or fewer days is sufficient for most nontraumatic pain not related to major surgery.

Providers should also evaluate risk factors before starting, and periodically during, opioid therapy, the CDC says in the guideline.

Risk factors include mental health conditions, substance use disorder and patients who are 65 and older, the guideline states.

The CDC says it “will revisit the guideline as needed to determine if evidence gaps have been sufficiently closed to warrant an update of the guideline.”

Comments on the proposed voluntary guideline will be accepted through Jan. 13. More than 90 comments had been submitted as of Wednesday, according to the regulations.gov website.