As you may know, last year the Centers for Disease Control (CDC) published a draft of some very controversial new opioid prescribing guidelines for those with chronic pain. These guidelines were meant to reduce the number of people in the U.S. who are taking opioids, as dependency, overdose, and abuse were on the rise. While the overall tone was to help people in the U.S., there was a lot of fear and worry surrounding these guidelines as they could make prescriptions much more difficult to obtain for those with a legitimate need.
New CDC opioid guidelines – 12 recommendations for prescribing opioids for chronic pain
On March 15, 2016, the CDC posted a largely unchanged final publication of these guidelines after listening to partner organizations and public feedback. Let’s take a look at some of the key points and the overall message of these final and new CDC opioid guidelines.
In an accompanying press release to the new CDC opioid guidelines, CDC Director Tom Frieden, M.D. stated that:
“More than 40 Americans die each day from prescription opioid overdoses, we must act now. Overprescribing opioids—largely for chronic pain—is a key driver of America’s drug-overdose epidemic. The guideline will give physicians and patients the information they need to make more informed decisions about treatment.”
So what kind of information do these new guidelines provide for chronic pain patients?
The CDC has defined chronic pain as pain that typically lasts more than three months or past the time of normal tissue healing. Using this definition, the CDC published a list of 12 recommendations they believe will help guide medical practitioners in the future when prescribing painkillers to chronic pain patients.
There are three main principals that resonant through the new guidelines:
- Non-opioid therapy is always preferred for chronic pain patients with an exception that includes active cancer, palliative, and end-of-life care.
- If opioids are deemed necessary after other methods, the lowest effective possible dosage should be prescribed to reduce risks, such as addiction and overdose.
- Providers should be cautious about prescribing opioids and always monitor patients closely for any signs of trouble.
Other recommendations include discussing the risks and benefits of opioid therapy with patients, conducting a drug test to assess prescribed medications, and reviewing patient’s history of controlled substances using state prescription drug monitoring programs.
All of this boils down to one thing: the CDC does not believe that opioids should be more regulated, considering the high risk of misuse, abuse, and addiction.
This fact is emphasized by the lack of evidence that supports the efficacy of long-term opioid treatments for chronic pain, as most research is focused on short-term benefits. The CDC believes the current painkiller epidemic is primarily fueled by physicians treating chronic pain with painkillers, without focusing on other alternative treatment options first. The purpose of these new guidelines is to assist doctors in helping their patients. In the words of Debra Houry, MD, and director of the CDC’s National Center for Injury Prevention and Control:
“This guideline will help equip them[doctors] with the knowledge and guidance needed to talk with their patients about how to manage pain in the safest, most effective manner.”
What kind of research backs up these guidelines?
These guidelines were created with input from numerous different sources, such as primary care professional societies, subject matter experts, and state agencies. The CDC also reviewed scientific literature and existing evidence-based guidelines to finely hone and establish a new general practice of opioid prescriptions.
Data from 2012 indicates that health care providers wrote prescriptions for 259 million patients in the form of opioid pain medications, which is “enough for every adult in the United States to have a bottle of pills.” This is a startling statistic as some opioids can be as addictive as heroin, which is why research has shown that some patients turn to heroin after they have run out of their prescriptions.
Between 1999 and 2014, more than 165,000 people in the U.S. died of overdosing on opioids and the Drug Abuse Warning Network estimated over 420,000 emergency departments visits related to abuse of these narcotics. This is on top of a recent study that shows that having a history of taking an opioid pain medication greatly increases the risk for developing a dependency on these drugs.
How does it affect chronic pain patients?
These guidelines are just that: non-binding suggestions that physicians should keep in mind when prescribing opioids to patients.
While these recommendations do not have the force of law behind them, it is quite possible that some states will construct laws out of these suggestions. Furthermore, some medical practitioners will pay deference to the CDC and will change their own practices to fall more closely in line with the CDC’s suggestions.
This could have potential ramifications for those who need opioids to effectively manage their pain condition and, in that way, create new barriers to relief. This could include doctors being more reluctant of prescribing opioids. It could also mean that new patients will have to go through multiple other non-opioid treatments before an opiate option is considered.
However, not everyone believes these guidelines will make a difference. According to Dr. Una McCann, professor of psychiatry at Johns Hopkins Medicine:
“Unfortunately, I’m not sure that the people who are prescribing these medications long-term are going to heed the pretty practical advice that’s provided by the Centers for Disease Control and Prevention.”
What do you think? Are these new guidelines too restrictive or are the new CDC opioid guidelines on the right track? Will you or someone you know be affected by these new recommendations?
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