(READ) CDC's new guidance for prescribing opioids and criticism of it

CDC revised its "Clinical Practice Guideline for Prescribing Opioids for Pain" on November 4.

Physicians writing in Medpage respond with the following critical commentary:

Before the CDC suffered a loss of trust over its handling of the COVID-19 pandemic, the agency had fumbled its response to the overdose crisis. Under its leadership, overdose deaths have continued to spiral, as people living with pain have lost access to vital medications.

One of its key missteps was the formulation and implementation of its 2016 prescribing guideline for chronic pain. On November 3 this year, the agency took partial corrective action, revising its approach that contributed to so many harms to people with pain.

In its update, the 2022 Clinical Practice Guideline for Prescribing Opioids for Pain, the CDC emphasizes flexibility in pain pharmacotherapy. It also rejects controversial dose and duration limits that had been widely misinterpreted by policymakers. For this welcome change to have meaning, however, the CDC must work proactively with regulators to rescind harmful policies that resulted from its prior guideline...

In its update, the 2022 Clinical Practice Guideline for Prescribing Opioids for Pain, the CDC emphasizes flexibility in pain pharmacotherapy. It also rejects controversial dose and duration limits that had been widely misinterpreted by policymakers. For this welcome change to have meaning, however, the CDC must work proactively with regulators to rescind harmful policies that resulted from its prior guideline.

Read the full commentary here.

CDC's summary of the new opioid guidelines is below:

Summary

This guideline provides recommendations for clinicians providing pain care, including those prescribing opioids, for outpatients aged ≥18 years. It updates the CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016 (MMWR Recomm Rep 2016;65[No. RR-1]:1–49) and includes recommendations for managing acute (duration of <1 month), subacute (duration of 1–3months), and chronic (duration of >3 months) pain. The recommendations do not apply to pain related to sickle cell disease or cancer or to patients receiving palliative or end-of-life care. The guideline addresses the following four areas: 1) determining whether or not to initiate opioids for pain, 2) selecting opioids and determining opioid dosages, 3) deciding duration of initial opioid prescription and conducting follow-up, and 4) assessing risk and addressing potential harms of opioid use. CDC developed the guideline using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Recommendations are based on systematic reviews of the scientific evidence and reflect considerations of benefits and harms, patient and clinician values and preferences, and resource allocation. CDC obtained input from the Board of Scientific Counselors of the National Center for Injury Prevention and Control (a federally chartered advisory committee), the public, and peer reviewers. CDC recommends that persons with pain receive appropriate pain treatment, with careful consideration of the benefits and risks of all treatment options in the context of the patient’s circumstances. Recommendations should not be applied as inflexible standards of care across patient populations. This clinical practice guideline is intended to improve communication between clinicians and patients about the benefits and risks of pain treatments, including opioid therapy; improve the effectiveness and safety of pain treatment; mitigate pain; improve function and quality of life for patients with pain; and reduce risks associated with opioid pain therapy, including opioid use disorder, overdose, and death.

Read the entire CDC publication of the new opioid guideliens at the link below:

https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm?s_cid=rr7103a1_w