CDC Updates Guidance on Opioid Prescriptions
CDC Updates Guidance on Opioid Prescriptions

In a shift from prior policy, the Centers for Disease Control and Prevention (CDC) proposed on February 22, 2022, new guidelines for prescribing opioid painkillers. The new guidance largely avoids figures on dosage strength and length of prescription and warns against abruptly or rapidly discontinuing pain pills for chronic pain patients. It directs physicians to individualize the process and use their best judgement in determining whether to prescribe opioids, and when they do, to start with the lowest effective dosage. The proposed guidelines encourage physicians to weigh the risks and benefits, and talk about them with the patient. 

Additionally, the new guidelines offer recommendations for “Determining whether, when, and how to taper opioids.” This is a comprehensive section, describing advice to give to patients prior to tapering them off opioids, ways to manage pain during tapering, and guidance on the rates at which to do so. 

The 229-page document addresses doctors and non-physician prescribers who treat three categories of patients: adults with acute pain (duration lasting less than one month); subacute pain (duration of one to three months); and chronic pain (duration of three months or longer). It does not apply to patients undergoing treatment for sickle cell disease, cancer, palliative or end-of-life care. The recommendations also do not apply to inpatient care received while hospitalized or in an emergency or observational setting.

Previously, the CDC suggested harsh dosage ceilings and duration limits that were far below common usage. Compounding this, many states then codified these recommendations and physicians began to follow them. This led to for help from those patients who relied most on opioids. 

This new proposed guidance has a number of obvious goals: encouraging prescribers to use their best judgement when making prescriptions; prescribing the lowest effective doses; and acknowledging these drugs are important for the treatment of chronic pain.

Even so, the document acknowledges how serious the opioid crisis is and goes into detail, citing addiction, depressed breathing, and altered mental status as some of the many dangers associated with opioids. Thus, limiting opioid prescriptions is still an overall goal. For example, the CDC recommends prescription medications like gabapentin and over-the-counter painkillers in place of opioids, or physical therapy and acupuncture as safer alternatives to prescription drugs. However, in contrast with the previous guidelines, these guidelines go to some lengths also to recognize the critical role opioids play in the medical management of pain. 

It is obvious the CDC still believes that opioids pose a serious problem to patients across the nation. However, the new recommendations highlight the important role opioids play in the medical management of pain. This is reflected in the changes to the guidance, which occurred at each step of an opioid prescription including when to prescribe them, how to prescribe them, and how to discontinue them. Overall, the new guidelines tend to favor flexibility and individualization of the patient when determining prescriptions. 

All who have a stake in the prescription of opioids are welcome to submit comments; this includes providers and patients who have personally experienced the effects of opioids.  Comments can be made here, and are open until April 11, 2022. 

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