The Centers for Disease Control and Prevention (CDC) has proposed new opioid prescribing guidelines that will drop its prior recommendation of specific limits on doses of opioid painkillers when treating chronic pain patients, among other changes.
The proposed update seeks to amend the CDC’s current guideline for prescribing opioids, issued in 2016, which had sparked a dramatic decline in pain pill prescriptions across the United States, but drew criticism from chronic pain sufferers, who contended they were being denied much needed pain relief.
“We began to hear how the guidelines were being misused and misapplied,” the CDC’s Christopher Jones, a co-author of the draft guidance, told The Associated Press.
The latest proposal acknowledged that studies have been published on doctors’ misapplication of the 2016 CDC Guidelines, which the agency pointed out were not mandatory in the first place and were intended to be flexible to “support, not supplant,” individualized patient care.
“Such misapplication includes extension of the 2016 CDC Guideline to patient populations not covered in the 2016 CDC Guideline (e.g., cancer and palliative care), opioid tapers and abrupt discontinuation without collaboration with patients, rigid application of opioid dosage thresholds, application of the Guideline’s recommendations for opioid use for pain to medications for opioid use disorder treatment, duration limits by insurers and by pharmacies, and patient dismissal and abandonment,” the CDC noted.
“These actions are not consistent with the 2016 CDC Guideline and have contributed to patient harm, including untreated and undertreated pain, serious withdrawal symptoms, worsening pain outcomes, psychological distress, overdose, and suicidal ideation and behavior.”
In the new proposed guidance, the CDC has left out recommendations of specific amounts and duration of pain medications it initially had in the 2016 version. This includes dropping the recommendation that doctors should avoid increasing dosage to a level equivalent to 90 milligrams of morphine per day, and the suggested approach of trying to limit opioid treatment for acute pain to three days.
The guideline, spanning 229 pages, is published on the Federal Register and is open to a 60-day public comment period from Feb. 10. The CDC will review the comments before issuing a final guidance, most likely before the end of the year.
The general intent of the revision is to foster individualized patient care, Jones told the AP.
The guidelines offers more options for treating the kind of short-term, acute pain that follows surgeries or injuries. It cites new research on alternative treatments to treat pain, which includes non-opioid prescription medications and non-drug options.
Per the text of the CDC draft guidelines, “The clinical evidence reviews found that non-opioid therapies are effective for many common types of acute pain and found insufficient evidence to determine long-term (>1 year) benefits of opioid therapy for chronic pain.
“Recommendations include that opioids should be used only when benefits for pain and function are expected to outweigh risks.”
The new guidelines advise clinicians to, when starting opioid medication, “prescribe the lowest effective dosage of immediate-release opioids for no longer than needed for the expected duration of pain severe enough to require opioids.”
Clinicians should “avoid abrupt discontinuation of opioids, especially for patients receiving high dosages of opioids, should avoid dismissing patients from care, and should ensure (provide or arrange) appropriate care for patients with pain and patients with complications from opioid use (e.g., opioid use disorder).”
The CDC has “substantially expanded” content on use of opioids for acute pain and on tapering opioids for patients on high doses for their chronic pain, it said.
For God has not given us a spirit of fear, but of power and of love and of a sound mind. (2 Timothy 1:7 New King James Version)