The U.S.Centers for Disease Control and Prevention has updated its opioid use guideline for prescribing opioids to treat pain, the agency announced on Thursday.
The new guidelines include 12 recommendations for clinicians who prescribe opioids for adult outpatients with short-term and long-term pain. This is the first time the CDC has updated its Guideline for Prescribing Opioids for Chronic Pain since 2016.
“Patients with pain should receive compassionate, safe, and effective pain care. We want clinicians and patients to have the information they need to weigh the benefits of different approaches to pain care, with the goal of helping people reduce their pain and improve their quality of life,” said Christopher M. Jones, PharmD, DrPH, MPH, Acting Director of CDC’s National Center for Injury Prevention and Control.
The new framework highlights determining whether to initiate opioids for pain, selecting opioids and dosages, deciding the duration of initial opioid prescription, assessing risk, and highlighting the harms of opioid use. According to the CDC, the guideline is a clinical tool to improve communication between clinicians and patients and empower them to make informed decisions about safe and effective pain care.
“The science of pain care has advanced over the past six years,” said Debbie Dowell, MD, MPH, chief clinical research officer for CDC’s Division of Overdose Prevention. “During this time, CDC has also learned more from people living with pain, their caregivers, and their clinicians. We’ve been able to improve and expand our recommendations by incorporating new data with a better understanding of people’s lived experiences and the challenges they face when managing pain and pain care.”
The guidelines suggest for clinicians prescribe nonpharmaceutical and nonopioid therapies for many common types of acute pain. The range of therapeutic options has historically been inaccessible to many patients because of factors such as inadequate clinician education, training, and guidance; unconscious bias; a shortage of pain management specialists, among other reasons, according to the CDC.
Under the new guidelines, clinicians are advised to view the patient’s history of controlled substance prescriptions using state prescription drug monitoring program (PDMP) data to determine whether the patient is receiving opioid dosages or combinations that put the patient at high risk for overdose
Opioid prescribing increased fourfold from 1999 to 2010, which paralleled a fourfold increase in overdose deaths involving prescription opioids during the same period, according to the CDC. The number of overall opioid prescriptions in the United States declined after 2012, and further declines have been observed after the release of the 2016 CDC Opioid Prescribing Guideline.
According to the 100-paged document, insurers, pharmacies and regulators sometimes misapplied the older guidelines, causing some patients significant harm, including "untreated and undertreated pain, serious withdrawal symptoms, worsening pain outcomes, psychological distress, overdose, and [suicide],".
The new guidelines require clinicians to evaluate the benefits and risks with patients within 1–4 weeks of starting opioid therapy for subacute or chronic pain or dosage escalation. It also calls for clinicians to regularly reevaluate the benefits and risks of opioid therapy with patients.
Before starting and periodically during the continuation of opioid therapy, clinicians are to evaluate the risk for opioid-related harms and discuss risks with patients. Clinicians should work with patients to incorporate into the management plan strategies to mitigate risk, including offering naloxone, according to the guideline.
Provisional data from CDC’s National Center for Health Statistics indicate there were an estimated 107,622 drug overdose deaths in the United States during 2021, an increase of nearly 15% from the 93,655 deaths estimated in 2020.
The 2021 increase was half of what it was a year ago when overdose deaths rose 30% from 2019 to 2020. Overdose deaths from synthetic opioids (primarily fentanyl), psychostimulants such as methamphetamine, and cocaine also continued to increase in 2021 compared to 2020.