The CDC today has released guidelines for primary care physicians prescribing opioids for chronic pain, calling it an “urgent response to the epidemic of overdose deaths” across the nation.
The number of opioid prescriptions and sales have quadrupled since 1999, fueling the current epidemic, according to the CDC. With 40 people dying every day from prescription opioid overdoses, CDC Director Thomas Frieden, MD, MPH, said the time to act is now.
“It’s become increasingly clear that opioids carry substantial risks but only uncertain benefits, especially compared with other treatments for chronic pain,” Frieden said in a telephone press conference. “Today, and every day this year, more than 40 Americans will die from a prescription opioid overdose in this country. Beginning treatment with an opioid is a momentous decision, and it should only be done with full understanding, by the clinician and the patient, of the substantial risks and the uncertain benefits involved.
“We know of no other medication that is routinely used for a nonfatal condition that kills patients so frequently.”
The new guidelines are aimed at the use of opioids in treating adults with chronic pain in primary care, outpatient settings, and are not meant for patients with cancer, palliative or end-of-life care. According to the CDC, primary care providers account for nearly half of all opioid prescriptions, and as many as one in four patients receiving long-term opioid therapy in primary care settings struggle with addiction.
Seeking to improve safety, minimize the harms associated with opioid use and focus on increasing the use of effective nonopioid treatments for chronic pain, the guidelines follow three key principles:
- Non-opioid therapy is always preferred for chronic pain, except in cases of active cancer, palliative and end-of-life care;
- When prescribing opioid treatment, the lowest effective dosage should be used; and
- Primary care providers should use caution when prescribing opioids, and closely monitor all patients receiving them.
The CDC’s new guidelines include 12 recommendations, covering medication selection, dosage, duration, patient monitoring and reassessment. They include:
- Opioids are not the first-line therapy, and should only be used when the benefits outweigh the risks;
- Establish goals for pain and function;
- Discuss risks and benefits with patients;
- Use immediate-release opioids, rather than extended-release, when starting;
- Use the lowest effective dosage;
- Prescribe shorter durations for acute pain;
- Frequently evaluate benefits and harms;
- Use strategies to mitigate risk;
- Review patients’ Prescription Drug Monitoring Program data;
- Use urine drug testing before starting opioid therapy;
- Avoid prescribing concurrent opioid and benzodiazepine treatments; and
- Offer treatment for opioid use disorder.
According to the CDC, officials developed the new guidelines after reviewing the best available scientific evidence, consulting with experts and considering thousands of comments from the public and various partner organizations.
The CDC’s guidelines follow the FDA calling for a reassessment of the agency’s approach to opioid medications, in response to what it called an “epidemic” of “misuse, abuse and dependence.” Both that FDA announcement and the new CDC guidelines are part of a larger, national campaign against opioid abuse led by HHS.
According to officials, there have been 165,000 overdose deaths related to prescription opioids in the United States since 1999. In addition, 4.3 million Americans have engaged in nonmedical use of prescription opioids in the last month. Nearly 2 million Americans aged 12 years and older have either abused, or were dependent, on prescription opioids in 2014.
“Combating the opioid epidemic is a national priority,” HHS Secretary Sylvia Burwell said during the CDC media conference call. “That’s why the president’s budget requests more than $1 billion to fight opioid use disorder and overdose, and we look forward to working with the Congress to secure this funding. It’s why governors throughout the nation are working from common ground to end this crisis, and it’s why public health leaders across the country are finding innovative ways to push back against these troubling statistics and what it means to people in their everyday lives. – by Jason Laday