The Centers for Disease Control and Prevention (CDC) finalized a voluntary guideline that officials hope will cause primary care physicians to proceed more cautiously in prescribing opioids for patients with chronic pain. Some groups representing physicians continue to express serious misgivings about the document and its potential effects, even though compliance is not mandatory.
The guideline, which was presented for public comment in December 2015, is limited to prescribing in outpatient primary care settings for chronic pain lasting longer than three months and not in the context of palliative care.
Within the guideline's 12 recommendations, three principles for improving patient care stand out, according to CDC:
- Non-opioid treatments are preferred for chronic pain not in the context of active cancer, palliative or end-of-life care.
- When the decision to prescribe opioids for chronic pain is made, the lowest possible effective dosage should be used in order to mitigate risk of dependence and overdose.
- Prescribers should exercise caution at all times and should monitor patients closely.
The guideline covers treatment initiation, dosing, duration of treatment, tapering, and risk assessment and mitigation. CDC director Thomas Frieden, MD, MPH, was direct in communicating the urgency of the guideline's release.
“More than 40 Americans die each day from prescription opioid overdoses, we must act now,” Frieden said in a statement. “Overprescribing opioids—largely for chronic pain—is a key driver of America's drug-overdose epidemic.”
The CDC also has developed materials, including a decision checklist, to assist providers in implementing the guideline's recommendations.