CDC releases new opioid prescribing guidelines

The U.S. Centers for Disease Control on Friday released its revised guidelines for opioid prescribing with new recommendations for providers that emphasize greater communication with patients and that opioids should not be on the front line for managing pain.

The last time the CDC released opioid guidelines was in 2016, of which triggered what many considered harsh reductions in pain medication prescribing and a host of laws and other regulations that left pain undertreated and unmanaged, according to the experts. The CDC document said some of the 2016 recommendations resulted in “misapplication” of strategies for limiting opioid prescribing and in some cases, abrupt discontinuation of opioids that jeopardized patients’ health.

The CDC said the new recommendations “aim to improve communication between clinicians and patients about the benefits and risks of prescription opioids and other pain treatment strategies; improve the safety and effectiveness of pain treatment; improve pain, function and quality of life for persons with pain; and reduce the risks associated with opioid pain treatment (including opioid use disorder, overdose and death) and with other pain treatment.”

The recommendations address tapering for patients who have been on long-term opioid therapy, urging physicians to utilize a slow approach to lowering medication strength and dosages: “If benefits outweigh risks of continued opioid therapy, clinicians should work closely with patients to optimize nonopioid therapies while continuing opioid therapy. If the benefits do not outweigh the risks of continued opioid therapy, clinicians should optimize other therapies and work closely with patients to gradually taper to lower dosages or, if warranted based on the individual circumstances of the patient, appropriately taper and discontinue opioids. Unless there are indications of a life-threatening issue such as warning signs of impending overdose (e.g., confusion, sedation, or slurred speech), opioid therapy should not be discontinued abruptly, and clinicians should not rapidly reduce opioid dosages from higher dosages.”

Among the recommendations, the CDC said nonopioid therapies “are at least as effective as opioids for many common types of acute pain” and that doctors “should maximize use of nonpharmacologic and nonopioid pharmacologic therapies.”

For chronic pain, the CDC says that nonopioid therapies “are preferred” and that before starting opioid therapy for subacute or chronic pain, “clinicians should discuss with patients the realistic benefits and known risks of opioid therapy, should work with patients to establish treatment goals for pain and function, and should consider how opioid therapy will be discontinued if benefits do not outweigh risks.”