CDC issues updated guidance on prescribing opioids

The Centers for Disease Control and Prevention (CDC) on Thursday issued new guidance for providers on prescribing opioids for chronic pain, updating previous recommendations that had been in place since 2016.

The CDC proposed new opioid prescription guidelines earlier this year amid criticisms that the old ones had resulted in worsened outcomes for patients with chronic pain.

The agency noted in its new guidance on Thursday that the release of the 2016 guidelines was associated with “accelerated decreases” in overall opioid prescribing, but acknowledged that the prior recommendations were “inconsistent” with the ultimate goal of facilitating “individualized, patient-centered care.”

The new guidance includes 12 updated recommendations for clinicians on prescribing opioid painkillers for adults with chronic pain.

These recommendations, which the CDC noted should not be used as “absolute limits of policy,” were divided into four categories: determining whether or not to start the use opioids for pain, selecting opioids and their dosages, determining the duration of treatment and follow-up, and assessing the potential risks in opioid use and addressing those harms.

“Our hope is that this new guideline, informed by the latest science and what we’ve learned about the human story of patients living with pain, can be a tool to help clinicians ensure the safest and most effective treatment for their patients is provided and that pain function and quality of life will improve for the millions of Americans dealing with pain each day,” Christopher Jones, acting director of CDC’s National Center for Injury Prevention and Control, said in a briefing on Thursday.

Many of the newly issued recommendations are similar to what was previously issued, such as advising clinicians to consider nonopioid therapies for acute pain and short-term pain, prescribing the lowest effective dose when starting treatment with opioid-naive patients, and discussing the known risks and benefits of opioid treatment before and during the duration of therapy.

Some changes include recommending that clinicians “carefully weigh benefits and risks” when changing opioid dosages and to “optimize nonopioid therapies while continuing opioid therapy.”

Instead of stating that clinicians should “avoid prescribing opioid pain medication and benzodiazepines concurrently whenever possible,” the newer guidance recommends that clinicians “use particular caution” when prescribing the two different kinds of medication.

The 2016 guidance had stressed the risks involved in prescribing both opioids and benzodiazepines. While the 2022 guidance still noted the risks, the CDC advised that the concurrent use of both medications can be “appropriate” for some circumstances.

The new recommendations also appeared to lean on a more individualized approach to prescribing opioids, specifying the differences between managing acute, subacute and chronic pain. The 2016 guidance made little reference to subacute pain, which is pain that is expected to last between one and three months.