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THURSDAY, Nov. 3, 2022 -- U.S. doctors prescribing opioids for pain relief now have a new -- and more nuanced -- set of guidelines from the federal government.
Issued by the U.S. Centers for Disease Control and Prevention on Thursday, the new recommendations incorporate new science developed since the last set of guidelines were released in 2016, at the height of the country's opioid epidemic.
For example, the guidelines now offer advice on short-term pain relief as well as treatment of chronic pain, Christopher Jones, acting director of the CDC's National Center for Injury Prevention and Control, said during a media briefing.
Doctors can also find advice on how to best taper off opioid use, if it's determined that a patient should no longer be on the medications, Jones added.
But most importantly, the 2022 guidelines are being presented not as hard-and-fast rules, but as a means to help doctors and patients decide the best course of treatment for their pain, Jones noted.
After the 2016 guidelines were issued, insurance companies and lawmakers placed inflexible and sometimes harsh limits on opioid prescribing that went beyond what the CDC had intended, Jones explained.
"The guideline recommendations are voluntary and meant to assist and guide shared decision-making between a clinician and patient," Jones said. "The guidelines should not be used as a rigid standard of care or inflexible policy or law. It's not meant to be implemented at absolute limits of policy or practice by clinicians, health systems, insurance companies and governmental entities."
About 1 in every 5 U.S. adults deals with chronic pain, according to the report published Nov. 4 in the CDC publication Morbidity and Mortality Weekly Report.
While opioids can be essential for pain management, they also carry the risk of addiction and overdose. Opioid prescriptions and OD deaths both increased fourfold between 1999 and 2010, the report noted.
The recommendations focus on four major areas, Jones said:
- Determining whether to prescribe opioids for pain in the first place.
- Selecting the appropriate opioid and dosage for each patient.
- Deciding how long the opioid treatment will last, and when to reassess whether it's still needed.
- Assisting the risks and addressing the potential harms of opioid use.
The 2016 set of guidelines focused solely on treatment of chronic pain, which is defined as pain that lasts more than three months, Jones said.
These new guidelines also include treatment of acute pain, which lasts less than a month and typically follows minor surgery or an injury, as well as subacute pain that lasts longer than a month but has not yet become chronic, Jones said.
"It's particularly important that the guidelines address this type of pain, as research shows that long-term opioid therapy often is initiated during the subacute time frame,” Jones said.
The 2022 guidelines also offer tips on safely ending opioid therapy.
"Practical tips on how to taper in an individualized, patient-centered manner have been added to help clinicians if the decision is made to taper opioids, and the guideline explicitly advises against abrupt discontinuation or rapid dose reductions of opioids," Jones said.
Making a patient quit opioid treatment cold turkey, or reducing their meds too quickly, can cause "very real harms," Jones explained.
"We tried to highlight that in the guidelines -- things like mental health crises, suicidal ideation or behavior, psychological distress and potentially even for some people seeking out opioids through other markets like illicit markets, in order to stave off withdrawal or to supplement if they are at too low of a dose," Jones said.
Specific recommendations from the report include:
- Maximizing the use of non-opioid painkillers before turning to opioids, particularly for subacute and chronic pain.
- Choosing immediate-release opioids rather than extended-release or long-acting opioids to treat any kind of pain.
- Prescribing the lowest effective dose of opioids, particularly for patients who haven't used the drugs before.
- Issuing short-term prescriptions for people recovering from surgery or injury.
- Regularly reassessing whether opioids are still needed to maintain a patient's quality of life.
- Offering the OD reversal drug naloxone to patients prescribed opioids.
- Reviewing medical records to determine a patient's specific risk regarding opioid use, to assess addiction risk and ward off interactions with other drugs like benzodiazepines.
- Making sure to arrange evidence-based treatment for patients who develop an opioid-use disorder.
"Pain and pain care remain a problem for millions of Americans, and there is much work to be done to advance equitable pain treatment in our country," Jones said.
"Our hope is that this new guideline, informed by the latest science and what we've learned about the human story of patients living with pain, can be a tool to help clinicians ensure the safest and most effective treatment for their patients is provided, and that pain, function and quality of life will improve for the millions of Americans dealing with pain each day," he said.
The U.S. Centers for Disease Control and Prevention has more about prescribing opioids for pain.
SOURCES: Nov. 3, 2022, media briefing with: Christopher Jones, PharmD, DrPH, MPH, acting director, U.S. National Center for Injury Prevention and Control; Morbidity and Mortality Weekly Report, Nov. 4, 2022
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