CDC opioid guidelines presses for prescription limits
- On Tuesday, the CDC released its guidelines for prescribing opioids for chronic pain.
- In 2014, opioids contributed to 28,648 deaths in the U.S., a record year. Healthcare providers wrote 259 million prescriptions for opioid pain relievers in 2012. This is enough for every American adult to have such a bottle of pills.
- The news comes on the heels of HHS allocating $94 million to 271 health centers to curb opioid misuse. There's been increasing government involvement in trying to prevent opioid-related deaths.
The guideline is for primary care providers treating adult patients for chronic pain in outpatient settings. "It is not intended for guiding treatment of patients in active cancer treatment, palliative care, or end-of-life care," the agency noted.
CDC also developed materials a decision checklist to assist providers with the recommendations. Among the 12 recommendations in the guidelines:
- Nonopioid therapy is preferred for chronic pain outside of active cancer, palliative, and end-of-life care;
- When opioids are used, the lowest possible effective dosage should be prescribed to reduce risks of opioid use disorder and overdose; and
- Providers should always exercise caution when prescribing opioids and monitor all patients closely.
The recommendations in the guidelines are voluntary. However, earlier this year, physicians were wary about the voluntary nature of the then-forthcoming guidelines. In addition, the AMA voiced its concern, while praising the guideline's goal, over the evidence base informing some of the recommendations, conflicts with existing state laws and product labeling, and possible unintended consequences associated with implementation.
“We know this is a difficult issue and doesn’t have easy solutions and if these guidelines help reduce the deaths resulting from opioids, they will prove to be valuable," said Patrice A. Harris, MD, the AMA board chair-elect and chair of the AMA Task Force to Reduce Opioid Abuse, adding, "If they produce unintended consequences, we will need to mitigate them. They are not the final word. More needs to be done, and we plan to continue working at the state and federal level to engage policy makers to take steps that will help end this epidemic.”
Modern Healthcare stated the guidelines are unlikely to affect any change in practice among physicians and many of the recommendations that physicians criticized remained intact in the final guidlines. Yet, Atul Gawande made this comment on Twitter:
#OpioidAddiction: The key point the media is missing -- The danger is not the 1st prescription, it's the 2nd. ihttp://1.usa.gov/1RkdaWb— Atul Gawande (@Atul_Gawande) March 16, 2016
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