The opioid epidemic continues to make a significant impact in the United States. The U.S Department of Health and Human Services reported that 10.1 million people misused a prescription opioid in 2019.1 In 2016, the Center for Disease Control and Prevention (CDC) compiled and released a set of practice guidelines for clinicians in order to help prevent the ongoing misuse of opioid therapies. The focus of the 2016 guidelines predominantly regarded chronic pain management.
CDC Opioid Guidelines Summary
In February 2022, the CDC released an updated version of the opioid practice guidelines. The purpose of this update is to explore the validity of the original guidelines and potentially expand on available guidance to include all clinicians prescribing pain medications for patients with acute pain (pain duration < 1month), subacute pain (pain duration of 1 – 3 months), or chronic pain (pain duration of > 3 months). The term “Clinicians” refers to physicians, nurse practitioners, physician assistants, oral health practitioners, internists, family physicians, surgeons, emergency clinicians, occupational medicine and physical medicine specialists, rehabilitation clinicians, and neurologists.
These guidelines DO NOT apply to:
- Pain treatment for sickle cell disease-related pain
- Cancer pain
- Palliative care
- End-of-life care
The updated guidelines focused on the following topics:
- Determining whether or not to initiate opioids for pain
- In order to minimize the use of opioid medications, clinicians should only consider initiating opioid therapy for acute pain if they believe the patient will benefit the most from it
- For many types of pain, including acute, subacute, or chronic pain, clinicians should continue to utilize non-opioid therapies, if possible
- Opioid selection and dosage
- When starting a patient on opioid therapy, fast-acting opioids are a preferred treatment option to longer-acting opioids
- Clinicians should utilize the lowest effective dose for opioid-naïve patients
- Clinicians should utilize caution when reducing or continuing opioid dosages for patients who have been on chronically higher dosages
- Opioid duration and follow-up
- Clinicians should only prescribe opioids for the expected duration of severe pain
- Clinicians should evaluate patients within 1 – 4 weeks of starting opioid therapy
- Assessing risk and addressing potential harms of opioid use
- Clinicians should evaluate the risk for the following opioid-related harms prior to starting and during the continuation of opioid therapy for patients who:
- Have a history of nonfatal overdose
- Use alcohol or other drugs
- Are over the age of 65
- Are pregnant
- Have kidney or liver insufficiency
- Have mental health conditions, and/or
- Have a substance use disorder
- Prescription drug monitoring programs should be reviewed for each patient receiving opioid prescriptions and/or other controlled medications
- Tapering
- Clinicians should utilize caution when reducing opioid dosages for patients who have been on chronic opioid therapy
- Patients on opioid therapy for a year or longer are more likely to tolerate a reduction in dosage when tapering at approximately 10% per month or slower
While these standards are intended to direct clinicians, they are not a replacement for clinical judgment. Clinicians and patients should continue to work collaboratively for patients on an individualized basis to achieve the best outcomes by utilizing the most effective and lowest risk therapies possible. Clinicians, insurers, and regulators should be aware that these guidelines are not a law, regulation, and/or policy that substitutes for FDA-approved labeling.
This article received contributions from our Senior Director of Clinical Operations Pharmacist Neil Welch and IWP’s Pain Management Specialist Pharmacist Julie Mantzouranis-Barthuly.
Reference:
- Assistant Secretary of Public Affairs (ASPA). (n.d.). What is the U.S. opioid epidemic?gov. Retrieved March 20, 2022, from https://www.hhs.gov/opioids/about-the-epidemic/index.html
- Dowell, D., Ragan, K. R., Jones, C. M., Baldwin, G. T., & Chou, R. (2022). CDC Clinical Practice Guideline for Prescribing Opioids–United States, 2022.