CDC Issues Guideline for Prescribing Opioids for Chronic Pain

Agency responds to overdose epidemic

The Centers for Disease Control and Prevention (CDC) has released new recommendations for prescribing opioid medications for chronic pain. The new guideline is for primary care providers—who account for nearly half of all opioid prescriptions—treating adult patients for chronic pain in outpatient settings. It is not intended to guide the treatment of patients in active cancer treatment, palliative care, or end-of-life care.

The U.S. is experiencing an epidemic of prescription opioid overdoses. Increased prescribing and sales of opioids—a quadrupling since 1999—helped create and fuel this epidemic, according to the CDC.

“More than 40 Americans die each day from prescription opioid overdoses. We must act now,” said CDC Director Tom Frieden, MD, MPH. “Overprescribing opioids—largely for chronic pain—is a key driver of America’s drug-overdose epidemic. The guideline will give physicians and patients the information they need to make more informed decisions about treatment.”

The guideline provides recommendations on the use of opioids in treating chronic pain (i.e., pain lasting longer than three months or past the time of normal tissue healing). While prescription opioids can be a part of pain management, they have serious risks, the CDC says. The new guideline aims to improve the safety of prescribing and to curtail the harms associated with opioid use, including opioid use disorder and overdose. The guideline also focuses on increasing the use of other effective treatments available for chronic pain, such as nonopioid medications or nonpharmacological therapies.

By using the guideline, primary care physicians can determine if and when to start opioids to treat chronic pain. The guideline also offers specific information on medication selection, dosage, duration, and when and how to reassess the patient’s progress and discontinue medication, if necessary.

Among the 12 recommendations in the guideline, three principles are key to improving patient care:

  • Nonopioid therapy is preferred for chronic pain outside of active cancer, palliative, and end-of-life care.
  • When opioids are used, the lowest possible effective dosage should be prescribed to reduce the risks of opioid use disorder and overdose.
  • Providers should always exercise caution when prescribing opioids and should monitor all patients closely.

“Doctors want to help patients in pain and are worried about opioid misuse and addiction,” said Debra Houry, MD, MPH, director of the CDC’s National Center for Injury Prevention and Control. “This guideline will help equip them with the knowledge and guidance needed to talk with their patients about how to manage pain in the safest, most effective manner.”

Source: CDC; March 15, 2016.