CDC issues first major update to opioid prescribing advice since 2016

CDC issues first major update to opioid prescribing advice since 2016

Physicians should not stop opioid treatment in patients with pain too abruptly and should consider offering naloxone, an overdose-reversing drug, to patients who have a history of substance use disorder or who will suddenly receive higher doses than they they have not developed tolerance.

Those are some of the key points in updated guidelines the Centers for Disease Control and Prevention released Thursday to help doctors prescribe opioids for pain. It is the first major update since 2016 and incorporates new research on pain management in light of the drug addiction crisis in the United States.

Officials went to great lengths to highlight a part of the report that says opioid pain treatment shouldn’t be stopped abruptly and doctors shouldn’t quickly reduce doses.

Patients who cut themselves off too quickly can develop mental health problems, including suicidal thoughts. In some cases, they will seek opioids on illicit markets if they are accidentally cut off and experience withdrawal.

“It’s a very real risk and we wanted to make sure we highlighted it,” said Christopher M. Jones, acting director of the CDC’s National Center for Injury Prevention and Control.

Chronic pain, defined as pain lasting at least three months, affects about 1 in 5 Americans, the CDC said. The guidelines are a long-awaited update that provides voluntary strategies, not rigid rules, for doctors who want to help individual patients.

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The guidelines also elaborate on when it is appropriate to use opioids for acute pain, which lasts a month or less, and subacute pain, which is defined as pain lasting between one and three months.

In all cases, according to the CDC document, “Physicians should prescribe the lowest effective dose of immediate-release opioids for no longer than is necessary for the expected duration of pain severe enough to require opioids.”

The report said that doctors should consider non-opioid treatments for acute pain, in particular, because many are as effective as opioid treatments. Doctors should only consider opioid therapy for acute pain “if the benefits are anticipated to outweigh the risks to the patient,” the CDC said.

CDC officials said the report’s primary goal was to help manage patients’ pain, but the broader context of the US addiction crisis hangs over its release.

More than 107,000 Americans died from drug overdoses in 2021. It was the highest death toll ever recorded and reignited questions about social isolation from the pandemic and efforts to stop deadly fentanyl from crossing borders.

Fentanyl, which is often trafficked from China and Mexico, is considered a kind of Russian roulette. Users often overdose on the highly potent synthetic opioid without realizing that it has been mixed with other drugs.

However, the overdose crisis has shed light on how people become addicted to opioids in the first place and renewed scrutiny of prescribing practices. A surge in prescription painkillers in the 1990s and 2000s has been widely blamed for the US opioid problem and led to lawsuits against drug manufacturers and distributors.

Dr. Jones said the main goal of Thursday’s update is to help the millions of people who experience pain from medical conditions or procedures, even though the CDC is aware of the potential for opioids to be misused or diverted into the wrong hands. .

“I think we can pursue both at the same time,” said Dr. Jones.

Many states have taken steps to expand the use of naloxone, a drug that can be given as a simple nasal spray or injection to reverse overdoses. At least 17 states have passed laws requiring or recommending the co-prescription of naloxone with opioids if patients have certain risk factors.

CDC guidelines say doctors should consider whether the patient or a household member is at risk of overdose or if they are suddenly prescribing a larger amount of opioids.

“Physicians should warn patients of an increased risk of overdose if they abruptly return to a previously prescribed higher dose due to loss of opioid tolerance, provide opioid overdose education, and offer naloxone,” the document says. the CDC.

CDC officials also said the guidelines should help doctors optimize care to be equitable across geographic and ethnic groups, a key item on the Biden administration’s health agenda.

“Geographic disparities contribute to increased use of opioids for conditions for which nonopioid treatment options might be preferred but are less available,” the CDC said. “For example, adults living in rural areas are more likely to be prescribed opioids for chronic non-malignant pain than adults living in non-rural areas.”

He also said that opioid prescribing safeguards, such as restrictions on refills, have been applied disproportionately to black patients even though white populations had higher rates of overdose deaths.

The CDC said the new guidelines do not apply to sickle cell disease and cancer treatment or end-of-life care. There are other guidelines for those conditions.

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