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The U.S. Centers for Disease Control and Prevention in November released revised guidelines for opioid prescribing with new recommendations for providers that emphasize greater communication with patients and state that opioids should not be on the front line for managing pain.
The last time the CDC released opioid guidelines was in 2016, which triggered what many considered harsh reductions in pain medication prescribing and a host of laws and other regulations that left pain undertreated and often unmanaged, according to experts.
“What the guidelines say is that opioids have a place; however, there still needs to be a very thoughtful approach to using opioids, and, whenever possible, the way out of pain is still non-drug and non-opioid,” said Dr. Marcos Iglesias, Hartford, Connecticut-based vice president and chief medical director of Travelers Cos. Inc. “I think it balanced some of the message that some in society took after the 2016 guidelines, which was that opioids are only bad.”
The CDC acknowledged in its new guidelines that some of its previous recommendations resulted in “misapplication” of strategies for limiting opioid prescribing and, in some cases, abrupt discontinuation of opioids that jeopardized patients’ health.
In what some experts have pegged as a more empathetic approach, the new guidelines stress that doctors should explore non-opioid therapies for chronic pain, and that if a person needs to be weaned off opioids that the process be gradual.
Nikki Wilson, Omaha, Nebraska-based senior director of clinical services for Mitchell Pharmacy Solutions, said the new approach is a good one, especially for the workers compensation industry, which has grappled with limiting opioids for “legacy” claimants who have been on the drugs for years.
Experts have said that taking a person off opioids once they are chemically dependent on them can be a dangerous balancing act.
The new guidelines will likely push more doctors to learn and develop weaning strategies, something that hasn’t been addressed in traditional medical training, Ms. Wilson said.
“The concern has been that there has to be some sort of experience around weaning,” she said. “It’s almost critical to engage a clinician who has experience in it, and not all prescribers do. It’s not their fault, it’s just something that is typically not addressed.”