On Tuesday, the Centers for Disease Control and Prevention (CDC) issued new recommendations for prescribing opioids in response to the growing epidemic of heroin and prescription painkiller addiction in the United States. The CDC Guideline for Prescribing Opioids for Chronic Pain offers a framework to guide health care providers, particularly primary care physicians, in the treatment and ongoing maintenance of patients with chronic pain.
According to the CDC, prescriptions and sales of opioids have more than quadrupled since 1999, with at least 40 people on average dying from an opioid overdose every day. Primary care physicians in outpatient settings prescribe more than half of all opioids used. Given the extent of the epidemic, federal health officials determined that more guidance was needed in this area of medicine.
On the agency’s website, the reasons for the new guidelines are described as follows:
“Improving the way opioids are prescribed through clinical practice guidelines can ensure patients have access to safer, more effective chronic pain treatment while reducing the number of people who misuse, abuse, or overdose from these drugs.” It goes on to say that the guidelines are designed to improve the treatment “for patients 18 and older in primary care settings. Recommendations focus on the use of opioids in treating chronic pain (pain lasting longer than three months or past the time of normal tissue healing) outside of active cancer treatment, palliative care, and end-of-life care.”
Although the CDC has provided similar recommendations in the past, those directions garnered less attention and have been largely ignored in recent years. The new guidelines emphasize that physicians should try to prescribe non-opioid painkillers whenever possible. If patients do require opioids, they should prescribe the lowest possible dose.
The clinical practices addressed in the new 2016 guidelines include:
• Determining when to initiate or continue the use of prescription painkillers for chronic pain outside of active cancer treatment, palliative care, and end-of-life care
• The specific selection of opioids, the dosage taken, duration of use, follow-up, and eventual discontinuation
• Assessing risk and addressing harms of long-term opioid use
A problem that remains is a lack of extended research into chronic pain management with opioids. Most placebo-controlled randomized trials have lasted only six weeks or less. In an editorial published Tuesday in the New England Journal of Medicine, CDC director Dr. Thomas Frieden argues that more long-term research is needed to understand the benefits and risk factors of opioids for the long-term treatment of chronic pain, Newsweek notes.
“Whereas the benefits of opioids for chronic pain remain uncertain, the risks of addiction and overdose are clear,” Dr. Frieden explained in the editorial. “Although abuse-deterrent formulations may reduce the likelihood that patients will inject melted pills, these formulations are no less addictive and do not prevent opioid abuse or fatal overdose through oral intake.”