CDC to update guidelines for prescribing opioids

by mcardinal

Lauren Dempsey, MS in Biomedicine and Law, RN, FISM News 


The CDC announced new plans to propose guidelines for prescribing opioid pain medications in order to “help people set and achieve personal goals to reduce pain and improve function.”

The previous recommendations were drafted in 2016 and recommended strict limitations on the prescription of pain drugs in an effort to abate the opioid crisis in America. The move, however, had faced much criticism from physicians and patients that suffer from chronic pain. The new guidance lifts some of these restrictions and encourages physicians to use their best judgment when prescribing the highly addictive medication to patients instead.

The CDC estimates that the economic costs of treating chronic pain and the associated conditions are $560 to $635 billion dollars annually.

The new recommendations will be open for public comment prior to the finalization of the draft in April of 2022. The most noticeable change is the CDC plans to remove the recommended ceilings on prescription doses, which had previously told doctors to avoid increasing prescribed doses to 90 milligrams of morphine per day; they also will no longer recommend that acute pain management be limited to three days. The agency will also recommend that physicians use alternative methods to treat pain that do not involve opioids. 

There were mixed responses from health care providers considering the devastating effects that addiction to painkillers have had.

Dr. Adriane Fugh-Berman from Georgetown University Medical Center commented that “there was nothing wrong with the original guidelines.” The purpose of the former guidelines was to prevent physicians from inappropriately prescribing painkillers and while the number of prescriptions has decreased, the number of drug overdoses from opioids has continued to rise. 

According to the CDC the number of drug overdose deaths between 2018 and 2019 increased by almost 5% and has quadrupled since 1999. In that same time period opioid-involved deaths increased by 6%, though prescription opioid deaths decreased by about 7%. This was after the CDC had released its recommendations for physicians to limit prescribing opioid medications. 

Opioids can be helpful in treating patient pain associated with cancer, after surgery, serious injuries and chronic pain. However, even when prescribed by a physician, patients can become dependent on the medications to control pain levels, due to their highly addictive nature. Though the guidelines were merely recommendations, many physicians applied them as a standard of practice when prescribing medications for patients.

Some physicians believe that this softer approach from the agency is a good thing, as it will be beneficial to patients and foster improved communication between them and their physicians. Dr. Samer Narouze, president of the American Society of Regional Anesthesia and Pain Medicine, highly praised the new recommendations from the CDC saying, “It’s a total change in the culture from the 2016 guidelines,” adding that the tone of the new draft “has a much more caring voice than a policing one, and it’s left room to preserve the physician-patient relationship.” The previous guidelines were seen as an edict to physicians to “just cut down on opioids — period.”

This is a somewhat surprising move, as the CDC has been working to prevent opioid overdoses and other opioid related harm to individuals. Since 2006 the agency closely monitored the opioid crisis and implemented programs “committed to preventing opioid misuse, overdose, and deaths” through strategies that will help protect Americans. The CDC has promoted a public health based approach and received $475 million for opioid overdose prevention as well as surveillance and the majority of these funds were used to support state-based prevention efforts.

The CDC will work with other government agencies as they update guidance including the FDA. The organization stated that it remains committed to focusing on the “misuse and abuse of opioid drugs” that “are claiming lives at a staggering rate” and “reducing life expectancy in the United States.”