CDC Revised Opioid Prescription Guidelines to Address Overkill
(Thursday, December 1, 2022)
In 2016, CDC published a list of recommendations for physicians prescribing opioid pain medications, to assist in judicious and diligent prescription of these critically needed drugs with high abuse potential. Five years later, CDC now believes that these “voluntary” recommendations may have hurt patient care by creating overtly restrictive opioid prescription policies, non-intended by the original recommendations. So, this month CDC revised the original recommendations to suggest more pragmatic policies that avoid overkill while maintaining reasonable precautions to avoid abuse. After the original 2016 national recommendations for opioid drug prescription, there was a fall in opioid prescriptions and a corresponding modest increase in prescriptions for non-opioid pain medications. However, several states and professional organizations used the CDC recommendations to implement much stricter policies that made it harder for patients with sickle cell disease, cancer-related pain, palliative care, and end-of-life care, who were not intended to be affected by CDC, “rapid opioid tapers and abrupt discontinuation without collaboration with patients, rigid application of opioid dosage thresholds, application of the guideline’s recommendations for opioid use for pain to medications for opioid use disorder treatment (previously referred to as medication assisted treatment), duration limits by insurers and pharmacies, and patient dismissal and abandonment.” These policies have unintentionally “contributed to patient harm, including untreated and undertreated pain, serious withdrawal symptoms, worsening pain outcomes, psychological distress, overdose, and suicidal ideation and behavior.” To address these issues, the new 2022 CDC recommendations emphasize that the recommendations are intended primarily for acute pain management (<7 days) or sub-acute pain management (1-3 months). Under the current recommendations, clinicians should still maximize use of nonopioid therapies and only consider opioid medications for short-term pain management based on a risk-benefit assessment for individual patients starting with the lowest effective dosage. Physicians should use a reasonable and pragmatic approach where patients may be prescribed opioid medications sooner on a case-by-case basis in collaboration with the patients. Tapering of dosing should not be abrupt with a recommended reduction of 10% per month or slower so the reduction is better tolerated. When there are disagreements between clinicians and patients about the rate of tapering, physicians should strive for a patient-centered shared-decision making approach, while avoiding abandoning the patient.
Dr. Mukesh Kumar
Founder & CEO, FDAMap
Linkedin: Mukesh Kumar, PhD, RAC