Comment In response to backlash from pain patients, the Centers for Disease Control and Prevention released updated guidelines Thursday that give clinicians more flexibility in how they prescribe opioids for short- and long-term pain. The new recommendations eliminate numerical dose limits and upper limits on the duration of treatment for chronic pain patients that were proposed in a landmark 2016 version of the agency’s advisory, which aimed to limit liberal use of the drug and control a raging epidemic. of opioids. These guidelines alerted physicians that starting opioid therapy was an important decision for patients. Parts of this non-binding document were widely misinterpreted, resulting in unintended harm to patients who benefited from opioid use without much risk of addiction. Patients reported being quickly stopped taking medications by doctors or seeing their medications abruptly stopped, the CDC noted in the new paper. Some insurance companies and pharmacies put strict limits on the length of prescriptions or stopped patients altogether. The new 100-page guidance — which remains only recommendations for doctors, nurses and others authorized to prescribe opioids — emphasizes returning the focus to the caregiver and patient deciding on the best course of treatment. “This guideline is really intended to be a mechanism to help patients and providers work together,” Christopher Jones, deputy director of the CDC’s National Center for Injury Prevention and Control, said in an interview Thursday. “We have relied on principles rather than thresholds.” Although a record 107,000 Americans died of opioid overdoses in 2021, much about the epidemic has changed since 2016. The number of opioid prescriptions, which peaked at more than 255 million in 2012, was still nearly 215 million when the CDC released the first set of guidelines. By 2020, that number had dropped to 142 million, reflecting efforts to reduce opioid use in favor of other approaches to pain and a recognition that many addictions begin with prescription drugs. The ongoing overdose epidemic is now primarily caused by illegal fentanyl, which is incorporated into a wide variety of street drugs and consumed, sometimes unknowingly, by users. However, chronic pain—defined as pain that lasts more than three months—remains one of the most common conditions suffered by patients in the US. In 2019, 1 in 5 adults reported chronic pain, and 1 in 14 said it limited life or work activities, according to the CDC. Chronic pain is blamed for $560 billion to $635 billion in direct medical costs, lost productivity and disability each year and contributes to 9 percent of suicides, the agency said. The new recommendations were proposed in February and sent out for public and expert comments before being approved by the CDC. They took into account research on opioids carried out since 2016. Like the previous version, they are not intended for the treatment of pain from sickle cell disease and cancer, or for palliative and end-of-life care, which require special attention from caregivers . Sidarth Wakhlu, associate director of the division of addiction at the University of Texas Southwestern Medical Center in Dallas, endorsed the new guidelines. “We needed more flexibility, an alternative to turning patients away from the drugs they really need,” he said in an email. “Of course we have to be careful because opioid addiction is a serious problem. But this new approach will be a huge help to those patients who would otherwise suffer from a lack of treatment.” At least one group had hoped the guidelines would keep numerical caps on one of the strong recommendations for prescribers. In a March 25 letter, Physicians for Responsible Opioid Prescribing, one of the fiercest critics of liberal opioid use, advised emphasizing a cap of 50 milligrams of morphine equivalents as the daily line at which prescribers are likely to face “diminishing returns ». This number is noted deeper in the guidance. Like the previous guidelines, the new version recommends that caregivers try non-opioid approaches to pain control before starting the drug. She also notes disparity in the care of people of color, some of whom are less likely to be referred to a pain specialist or receive postpartum pain assessments than Whites. Blacks also receive lower doses of painkillers than their white peers, it said. The new recommendations also include advice on ways doctors and patients can discuss reducing medication. a warning that clinicians should “weigh the benefits and risks and exercise caution when changing the dose of opioids;” and a notice that they should “regularly reassess the benefits and risks of continued opioid therapy with patients ». “There’s no way they’re intended to be applied as a one-size-fits-all,” Jones said. “These are just guides.”
