CDC Loosens Guidelines for Doctors Prescribing Opioids

“Socalj” for Borderland Beat

The nation’s top public health agency on Thursday softened its guidelines for U.S. doctors prescribing oxycodone and other opioid painkillers.

The Centers for Disease Control and Prevention's new recommendations are an update to 2016 guidelines that added momentum to a decline in opioid painkiller prescriptions.

The previous guidance succeeded in reducing inappropriate and dangerous prescribing, some experts say. But they also were seen as a barrier to care, with some pharmacists refusing to fill prescriptions as doctors wrote them. The new guidelines are designed to ensure that patients get compassionate and safe pain care, CDC officials said.

“Patients with pain should receive compassionate, safe, and effective pain care. We want clinicians and patients to have the information they need to weigh the benefits of different approaches to pain care, with the goal of helping people reduce their pain and improve their quality of life,” said Christopher M. Jones, PharmD, DrPH, MPH, Acting Director of CDC’s National Center for Injury Prevention and Control.

The 2022 Clinical Practice Guideline addresses the following areas:

1. Determining whether to initiate opioids for pain
2. Selecting opioids and determining opioid dosages
3. Deciding duration of initial opioid prescription and conducting follow-up
4. Assessing risk and addressing potential harms of opioid use

The Clinical Practice Guideline supports the primary prevention pillar of the HHS Overdose Prevention Strategy – supporting the development and promotion of evidence-based treatments to effectively manage pain.

The guideline is a clinical tool to improve communication between clinicians and patients and empower them to make informed decisions about safe and effective pain care. The recommendations are voluntary and provide flexibility to clinicians and patients to support individualized, patient-centered care. They should not be used as an inflexible, one-size-fits-all policy or law or applied as a rigid standard of care or to replace clinical judgement about personalized treatment.
A draft released in February received 5,500 public comments. Some modifications were made, but several main changes stayed in place, including:

• The CDC no longer suggests trying to limit opioid treatment for acute pain to three days.

• The agency is dropping the specific recommendation that doctors avoid increasing dosage to a level equivalent to 90 milligrams of morphine per day.

• For patients receiving higher doses of opioids, the CDC is urging doctors to not abruptly halt treatment unless there are indications of a life-threatening danger. The agency offers suggestions on tapering patients off the drugs.

Opioids painkillers can be addictive — even when used under doctors’ orders — and were identified as a big reason for a rise in U.S. drug overdoses that began more than two decades ago. Other drugs have overtaken them in overdose statistics, and illicit fentanyl is now the biggest driver of deaths.

CDC Also States “Drug Overdose Deaths Remain High”

More than 932,000 people have died since 1999 from a drug overdose.1 In 2020, 91,799 drug overdose deaths occurred in the United States. The age-adjusted rate of overdose deaths increased by 31% from 2019 (21.6 per 100,000) to 2020 (28.3 per 100,000).

Opioids—mainly synthetic opioids (other than methadone)—are currently the main driver of drug overdose deaths. 82.3% of opioid-involved overdose deaths involved synthetic opioids.

Opioids were involved in 68,630 overdose deaths in 2020 (74.8% of all drug overdose deaths).

Drug overdose deaths involving psychostimulants such as methamphetamine are increasing with and without synthetic opioid involvement.

From 1999 to 2020, more than 263,000 people died in the United States from overdoses involving prescription opioids. Overdose deaths involving prescription opioids nearly increased by five times from 1999 to 2020.

Source CDC, ABC News, CDC