Centers for Disease Control and Prevention (CDC) Releases New Guidelines for Prescribing Opioids for Chronic Pain
The opioid epidemic in the U.S. continues to worsen, with overdose death rates climbing in most states. The Centers for Disease Control and Prevention (CDC) data reveal that 28,648 deaths were linked to prescription opioids and heroin in 2014. According to the Department of Health and Human Services (HHS) 2014 National Survey on Drug Use and Health, 4.3 million adolescents and adults reported non-medical use of prescription opioids.
To stem this epidemic, the CDC has published new clinical guidelines for doctors who prescribe opioids to treat chronic pain. The guidelines address three important issues:
- When doctors should prescribe, or continue prescribing, opioids for chronic pain.
- Which medication to prescribe, at what dose, and for how long.
- How to assess, from the start, the risks of opioid use and how to mitigate the potential harms.
In developing the guidelines, the CDC conducted a review of published studies of opioid therapy, and concluded that there is insufficient evidence supporting the use of opioid painkillers to treat noncancerous-related, chronic pain. The CDC recommends that physicians try treating chronic pain patients with non-opioid medications (like Tylenol) or physical therapy first, and only resort to opioid painkillers if these other therapies fail. When opioids are prescribed, doctors should discuss the risks and benefits with the patient, and evaluate patients every month or so to confirm opioids are in fact being taken as prescribed and improving their symptoms. The CDC recommends doctors prescribe the lowest effective dose and use only immediate release formulations for chronic pain, not extended-release or long-acting formulations.
Chronic pain is a serious condition that warrants comprehensive and interdisciplinary assessment and treatment. However, over the last two decades there has been a growing over-reliance on opioid painkillers prescribed by primary care physicians as the sole method of treatment, driven in part by the pharmaceutical industry’s claims that opioid painkillers do not lead to addiction. While doctors who treat chronic pain strive to act in their patients’ best interest, many have been unduly influenced by the pharmaceutical industry and lack sufficient clinical information about the risks and benefits of opioid medications as a treatment for chronic pain. In addition, most doctors are not trained to identify or treat addiction when it occurs. The CDC guidelines address this issue by offering clear, research-based recommendations to guide patient care.
Although we believe that the CDC guidelines show promise in reducing the number of opioid overdose deaths in the U.S., the guidelines alone will not end the opioid epidemic. Doctors may have contributed to this problem, but they did not cause it single-handedly and cannot reverse it alone. To stem the rising tide of opioid overdose deaths, we need broader measures to help fight addiction, such as:
- Safer and more effective medications for treating chronic pain that can be prescribed instead of opioids
- The inclusion of addiction in medical school curriculum, so doctors learn how to identify and treat this disease as part of their clinical training
- Universal insurance coverage for the full spectrum of effective addiction treatments
- Fewer restrictions on buprenorphine and methadone, two medications that have been proven to treat opioid addiction
- Public health initiatives to prevent risky substance abuse
- Public education to decrease the stigma that surrounds addiction
In addition, changes are needed in the ways that hospital and physician performance is judged on the basis of providing assertive pain management. Center on Addiction recently joined dozens of health care organizations, medical experts and consumer advocacy groups to put forth a petition that requests changes to mandatory pain assessment in all patients and in all medical settings, an unwarranted rule that can lead to overtreatment of opioids. This petition is a step in the right direction to ensuring that the current push for more conservative prescribing practices is not undermined by other forces in the healthcare industry.
Implementing these measures will take time. In the meantime, the CDC guidelines fill the gap by helping doctors to make better decisions about safely prescribing opioids.
Mark Stovell is a freelance blogger for Center on Addiction