CDC on Tuesday released new guidelines recommending that primary care doctors should generally refrain from prescribing opioid painkillers for chronic pain.
The agency developed the guidelines after considering expert feedback and comments submitted by more than 160 organizations and the public. The guidelines do not apply to patients receiving cancer treatment, end-of-life care, or palliative care.
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CDC Director Tom Frieden says the guidelines aim to help "chart a safer course that allows patients with severe pain to be treated but recognizes that for most patients with chronic pain the risks of prescription opiates will far outweigh the uncertain benefits."
The guidelines recommend that primary care providers, who currently issue almost 50 percent of prescriptions for opioid painkillers, instead offer patients alternative treatments for chronic pain.
Alternative treatments can include behavioral health therapy, exercise, physical therapy, and non-opioid painkillers, such as ibuprofen.
When opioid drugs are necessary for treatment, CDC suggests that providers prescribe the lowest possible dosages that would still be effective.
In addition, CDC said says opioids prescribed to patients with short-term, acute pain should be limited to no more than a three-day supply in most cases. The agency notes that prescriptions for more than a seven-day supply "will rarely be needed."
The guidelines also say that physicians should closely monitor patients who are prescribed opioid drugs. For example, CDC suggests that providers conduct urine tests on such patients before starting opioid treatments and continue to conduct such tests at least annually.
Further, CDC advised providers to:
- Check in with patients to ensure they are not misusing prescription or illicit drugs;
- Monitor the effectiveness of prescribed drugs; and
- Watch for potentially unsafe drug interactions.
The guidelines also recommend that physicians check prescription drug monitoring databases to ensure individuals are not already receiving prescription opioids from other providers.
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The guidelines are nonbinding and physicians cannot be penalized for non-compliance. Still, Frieden says he expects some states and health insurers to implement parts of the recommendations in an effort to bolster patient safety.
Some stakeholders who had criticized the federal government for lagging behind states in addressing the opioid epidemic are applauding the new guidelines.
Andrew Kolodny, executive director of Physicians for Responsible Opioid Prescribing, says, "This is the first time the federal government is communicating clearly to the medical community that long-term use [of prescription opioids] for common conditions is inappropriate." He calls the guidelines "one of the most significant interventions by the federal government."
Sen. Joe Manchin (D-W.Va.) in a statement calls the guidelines "a critical part of [the] fight to end" the U.S. opioid misuse epidemic.
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Others say providers might feel compelled to follow the guidelines out of fear of lawsuits, even though they are not required to comply.
Myra Christopher, director of the Pain Action Alliance to Implement a National Strategy, says, "These will not be seen as voluntary," adding, "These will become the definition of the standard of care, because of the clout of" CDC.
The American Medical Association in a statement says it "largely support[s]" the guidelines, but cautions against the "potential effects of strict dosage and duration limits on patient care" (Sullivan, The Hill, 3/15; Tavernise, New York Times, 3/15; McKay, Wall Street Journal, 3/15; Ross Johnson, Modern Healthcare, 3/15; Demirjian/Bernstein, "PowerPost," Washington Post, 3/15).
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