After months of anticipation, the Centers for Disease Control and Prevention has formally released its proposed guidelines for opioid prescribing. The effort comes amid an epidemic of opioid use and abuse — every day, an estimated 44 Americans overdose and die after taking opioid painkillers.
The agency wants to encourage doctors to become more circumspect about their prescribing. A new study in the Journal of the American Medical Association found that most opioid painkillers are prescribed by ordinary family doctors and general practitioners, not a few so-called bad apples.
As noted previously, this is a crucial effort. With 14 million Americans suffering severe pain each day, ensuring that these health care providers have useful guidance is critical to stemming the tide of painkiller addiction. And so, the CDC guidelines are now open for public comment through Jan. 13.
Here are some of the key recommendations:
1 — Providers should only consider adding opioid therapy if the expected benefits for both pain and function are anticipated to outweigh risks;
2 — Before starting long-term opioid therapy, physicians should establish treatment goals and only continue prescribing if there is “clinically meaningful improvement” that outweighs safety risks;
3 — When starting opioid therapy, doctors should prescribe short-acting opioids instead of extended-release, long-acting opioids;
4 — When opioids are started, doctors should prescribe the lowest possible effective dosage;
5 — When prescribing for acute pain, the lowest effective dose of short-acting opioids should be prescribed and only in quantities for the expected duration of the pain;
6 — Providers should evaluate patients within one to four weeks of starting long-term opioid therapy and again at least every three months to assess benefits and harms of continued treatment;
Already, though, opposition to the guidelines exists.
A federal government panel, the Interagency Pain Research Coordinating Committee, plans to file a formal objection to the guidelines over concerns the level of evidence cited to support the proposal is too low.
Also, the American Cancer Society and an umbrella group of leading pain societies complain the guidelines are too restrictive and some patients will be denied much-needed pain relief. However, some physicians counter that these groups are too closely tied to drug makers, which worry about reduced prescribing.