CDC updates clinical guidance on prescribing opioids for pain - Healio

The CDC has released updated and expanded objective signifier guidance connected prescribing opioids to patients with short- and semipermanent pain.

The guidance, which was archetypal proposed successful February, replaces the agency’s 2016 recommendations.

The CDC has released updated objective signifier guidance connected prescribing opioid attraction for pain, including categories specified arsenic acute symptom and subacute pain. Source: Adobe Stock.

“Patients with symptom should person compassionate, harmless and effectual symptom care. We privation clinicians and patients to person the accusation they request to measurement the benefits of antithetic approaches to symptom care, with the extremity of helping radical trim their symptom and amended their prime of life,” Christopher M. Jones, PharmD, DrPH, MPH, acting manager of CDC’s National Center for Injury Prevention and Control, said successful a property release.

According to CDC data, of much than 91,000 cause overdose deaths that occurred successful the U.S. successful 2020, 74.8% (n = 68,630) progressive an opioid. About 10,000 of these deaths were attributed to medicine opioids.

The updated guidance includes 12 recommendations that code whether to initiate opioid therapy for pain, selecting opioids and dosages, determining the duration of attraction and assessing the risks and benefits. The guidelines counsel clinicians to:

• maximize nonpharmacologic and nonopioid pharmacologic therapies arsenic warranted for circumstantial situations and patients, lone see opioid attraction for acute symptom if the benefits outweigh the risks, and sermon the risks and benefits with the diligent beforehand;
• understand that nonopioid therapies are preferred for subacute and chronic pain, enactment with patients to found attraction goals and see however opioid attraction volition beryllium discontinued if the risks outweigh the benefits;
• prescribe immediate-release opioids alternatively of extended-release and long-acting opioids erstwhile starting opioid therapy for acute, subacute oregon chronic pain;
• prescribe the lowest effectual dosage of opioid therapy for opioid-naive patients with acute, subacute oregon chronic pain, usage caution erstwhile continuing for subacute and chronic symptom and debar expanding dosage levels that are “likely to output diminishing returns successful benefits comparative to risks”;
• weigh the risks and benefits erstwhile changing medicine dosages for patients who are already connected opioid therapy, portion utilizing different treatments and tapering patients disconnected opioid therapy if the risks outweigh the benefits;
• use nary greater quantity than needed for the expected duration of terrible symptom erstwhile utilizing opioid therapy for acute pain;
• evaluate the risks and benefits wrong 1 to 4 weeks of starting opioid therapy for subacute oregon chronic symptom oregon of dose escalation;
• evaluate the risks for opioid-related harms and sermon harms with patients earlier starting therapy and periodically passim the continuation, portion moving with patients connected absorption program strategies to mitigate risks;
• review the patient’s past of controlled substance prescriptions utilizing authorities medicine cause monitoring programme information to find whether the opioid doses oregon combinations puts them astatine precocious hazard for overdose earlier starting them connected opioid therapy;
• consider the benefits and risks of toxicology investigating to measure prescribed medications arsenic good arsenic different prescribed and nonprescribed controlled substances;
• use caution erstwhile prescribing opioid symptom medicine and benzodiazepines concurrently, and see whether the benefits outweigh the risks erstwhile prescribing opioids with different cardinal tense strategy depressants; and
• offer treatments with evidence-based medications for opioid usage disorder, portion avoiding detoxification owed to accrued risks for resuming cause use, overdose and overdose death.

The CDC noted that these recommendations “should not beryllium utilized arsenic an inflexible, one-size-fits-all argumentation oregon law,” but are alternatively voluntary and connection flexibility to patients and clinicians.

In a telebriefing, Jones touched down connected respective cardinal differences betwixt the 2016 and 2022 guidance that bespeak “the expanded scope of the disposable technological evidence.”

“While the 2016 line focused astir exclusively connected chronic pain, the line released contiguous besides includes recommendations for treating acute and subacute pain,” helium said.

Jones said it was peculiarly important that the guidance addressed these categories of pains, citing erstwhile probe that has shown opioid therapy is initiated during the subacute symptom timeframe.

The guidance was besides expanded from a absorption connected clinicians successful a superior attraction mounting to a broader scope of providers and specialties, and it contains caller accusation connected some tapering opioid attraction and the usage of nonopioid medications and treatments for pain.

“We’ve besides expanded the grounds basal astir the usage of opioid symptom medications and different symptom treatments successful definite groups, similar older adults and large people, and successful radical with conditions posing peculiar risks, specified arsenic those with a past of substance usage disorder,” Jones said.

He added that the updated guidance besides specifies which recommendations use to patients being considered for opioid therapy, “versus those who person been receiving opioids arsenic portion of ongoing care.”

Responding to media comments, Jones discussed the CDC’s efforts to guarantee the due usage of the updated guidance, peculiarly since the 2016 guidance was “misimplemented” by clinicians, putting patients astatine risk. According to a insubstantial published by CDC researchers successful 2019, galore clinicians inappropriately applied the 2016 guidance to patients receiving crab treatment, those experiencing acute sickle compartment crises oregon post-surgical pain, and those receiving medication-assisted attraction for opioid usage disorder. In addition, galore clinicians abruptly discontinued oregon de-escalated opioid doses, which Jones said could origin “very existent harms,” including intelligence wellness crises, suicidal ideation oregon behaviour and intelligence distress. Abrupt discontinuation oregon de-escalation could besides pb immoderate patients to question retired opioids done illicit markets “in bid to stave disconnected withdrawal oregon to supplement if they are astatine excessively debased of a dose,” helium said.

Jones stated that the CDC volition look retired for practices and policies that are inconsistent with the updated guidance and usage them arsenic an “educational opportunity.”

“We’ll beryllium monitoring and engaging with objective partners successful diligent organizations to besides rise consciousness for wherever those circumstances whitethorn occur,” helium said.

References:

• CDC media telebriefing: Updated objective signifier guidelines for prescribing opioids for symptom https://www.cdc.gov/media/. Accessed Nov. 3, 2022.
• CDC releases updated objective signifier line for prescribing opioids for pain. Published Nov. 3, 2022. Accessed Nov. 3, 2022.
• Death complaint maps & graphs. https://www.cdc.gov/drugoverdose/deaths/index.html. Accessed Nov. 3, 2022.
• Dowell D, et al. MMWR Morb Mortal Wkly Rep. 2022;doi:10.15585/mmwr.rr7103a1.
• Overdose decease rates. https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates. Accessed Nov. 3, 2022.