Today the Centers for Disease Control and Prevention (CDC) announced that new advice on their Guideline for Prescribing Opioids for Chronic Pain will be published in the New England Journal of Medicine (NEJM).
Created in 2016 for primary care clinicians prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care, the Guideline aims to:
- improve communication between clinicians and patients about the risks and benefits of opioid therapy,
- improve the safety and efficacy of pain treatment,
- and reduce the risks associated with long-term opioid therapy, including opioid use disorder, overdose, and death.
Since the Guideline was released, many health care providers, insurers, pharmacies, and states have made unprecedented efforts to address the opioid crisis by curbing overprescribing, misuse, and overdose.
However, the NEJM commentary highlights the CDC’s concerns about the misinterpretation and overapplication of the recommendations of the Guideline, which may put patients at risk. Namely, that some clinicians are applying the recommendations to patients outside of its intended group—chronic pain patients; applying them in a way that results in patients being abruptly “cut off” of opioid medication, which can result in severe withdrawal symptoms, and cause some patients to seek other sources of opioids; and applying them to patients who are receiving medication-assisted treatment for a substance use disorder by denying patients access to a crucial component of evidence-based treatment.
A group called Health Professionals for Patients in Pain (HP3) sent an open letter on March 6th urging the CDC to “clarify that its otherwise reasonable guideline didn’t mandate that doctors suddenly cut off or reduce the supply of opioid pain relievers to patients who need them.” Dr. Sally Satel, a member of HP3, writes that the commentary moves this country toward a more balanced opioid policy, which will be welcomed by “the millions of Americans who suffer from chronic pain. No government agency will force their physicians to deprive them of the medications that make relief, and life itself, possible.”
With this commentary, the CDC clarifies the initial recommendations and encourages clinicians to weigh the risks and benefits of opioid treatment for chronic pain patients, communicate with patients about tapering their doses, taper doses slowly, carefully monitor patients who are taking high doses of opioid medication and minimize the risk of overdose, explore non-opioid treatment options whenever possible, and offer or arrange medication-assisted treatment to patients with opioid use disorders.
Read the press release: CDC Advises Against Misapplication of the Guideline for Prescribing Opioids for Chronic Pain