How many will adopt the new CDC opioid guidelines?

After several months of debate, the Centers for Disease Control and Prevention (CDC) finally published its Guideline for Prescribing Opioids for Chronic Pain on March 15. The agency’s recommendations are aimed towards primary care physicians, since family physicians alone account for 15.3 million opioid prescriptions annually. Currently, 44 Americans overdose and die each day after abusing prescription painkillers and the CDC hopes its recommendations can noticeably reduce the use of opioids in pain care.  

"The science of opioids for chronic pain is clear," said CDC Director Tom Frieden, MD, MPH, in a news teleconference. "For the vast majority of patients, the known, serious and all too often fatal risks far outweigh the unproven and transient benefits, and there are safer alternatives."

However, the Guideline for Prescribing Opioids for Chronic Pain are voluntary and some question how many in the healthcare sector will adopt them.  Several healthcare professionals and patient groups protested the guidelines after their first draft was unveiled for comment, claiming they were too restrictive on pain care. The outcry was enough that the CDC had to organize an extra review process for the guidelines back in January. 

Now it’s up to healthcare facilities, including those who protested the guidelines, to decide if they will follow the CDC’s recommendations and to what extent.

The chair-elect of the American Medical Association, Patrice Harris, MD said that while they were “largely supportive” of the new guidelines, they still had some lingering qualms about how they will be implemented.

"We remain concerned about the evidence base informing some of the recommendations, conflicts with existing state laws and product labeling, and possible unintended consequences associated with implementation, which includes access and insurance coverage limitations for non-pharmacologic treatments, especially comprehensive care, and the potential effects of strict dosage and duration limits on patient care,” she said in a press release. “We know this is a difficult issue that doesn’t have easy solutions and if these guidelines help reduce the deaths resulting from opioids, they will prove to be valuable. If they produce unintended consequences, we will need to mitigate them. They are not the final word.”

Meanwhile the American College of Physicians has announced its full support of the guidelines. During an interview with Medscape Medical News, American Pain Society President Gregory Terman, MD, PhD, said the final draft of the guidelines contain improvements over the original, protested version. He went on to say the updated guidelines gave physicians more flexibility to operate around "specific numbers."

The guidelines consist of 12 recommendations, including:

1.    Using non-pharmacologic and non-opioid therapy for chronic pain whenever possible.

2.    Establishing treatment goals before starting long-term opioid therapy. Physicians should only continue to prescribe opioids if there is “clinically meaningful improvement” that outweighs safety risks.

3.    Discussing the risks and benefits of opioids with patients before prescribing them.

4.    Using short-acting opioids instead of extended-release, long-acting drugs to treat chronic pain.

5.    Prescribing opioids in their lowest effective dosage.

6.    Using short-term opioid treatments instead of long-term treatments for acute pain care. Usually three days’ worth of opioids will be enough, though up to seven days is sometimes permissible.

7.    Patients should be evaluated within one to four weeks of beginning opioid therapy for chronic pain and be reevaluated at once every three months afterwards to assess the pros and cons of continued treatment.

Read The Joint Commission’s “Facts about Pain Management” page and view its Sentinel Event Alert 49, dealing with safe use of opioids in hospitals.