The CDC has issued new, more flexible guidelines for prescribing opioids.


In response to the backlash from patients, the Centers for Disease Control and Prevention released updated guidelines Thursday that will give clinicians more flexibility in how they prescribe opioids for short-term and long-term pain.

The new proposals eliminate the quantitative limits and time limits on treatment for patients with long-term chronic pain that were mandated by the agency’s 2016 recommendation to curb liberal use of the drug and control the growing opioid epidemic. These guidelines remind doctors that starting opioid therapy is a critical decision for patients.

Parts of that non-binding document have been widely misinterpreted, causing unintended harm to patients who benefit from opioid use without much addiction. The CDC acknowledged in the new document that patients have seen doctors stop medications too quickly or have their medications stopped abruptly. Some insurers and pharmacies place strict limits on the duration of prescriptions or turn patients away entirely.

The new 100-page guideline — which leaves only recommendations for doctors, nurse practitioners and others authorized to prescribe opioids — puts the emphasis back on the caregiver and the patient to decide the best course of treatment.

“This guideline is really a mechanism intended to help patients and providers work together,” Christopher Jones, acting director of the CDC’s National Center for Injury Prevention and Control, said in an interview Thursday. “We are based on more principles than limitations.”

In the year While 107,000 Americans will die from opioid overdoses in 2021, much about the epidemic has changed since 2016. In the year The number of opioid prescriptions was still around 215 million, up from more than 255 million in 2012, when the CDC first released its data. A set of instructions.

In the year By 2020, that number will drop to 142 million, a reflection of efforts to reduce opioid use and the recognition that many addictions begin with prescription drugs.

The ongoing overdose epidemic is now primarily fueled by illegal fentanyl laced into various street drugs and sometimes unwittingly consumed by users.

Yet chronic pain—defined as pain lasting more than three months—remains one of the most common conditions American patients suffer from. In the year In 2019, 1 in 5 adults reported chronic pain, and 1 in 14 said it limited life or work activities, according to the CDC. Chronic pain is responsible for between $560 billion and $635 billion in direct medical costs, lost productivity and disability each year, and contributes to 9 percent of suicides, the organization said.

The new recommendations were submitted in February and sent to the public and experts for comment before being adopted by the CDC. They consider studies on opioids that have been done since 2016. Like the previous version, they are not intended to treat sickle cell disease and cancer, or palliative and end-of-life care, which require special attention from caregivers.

Siddharth Waklu, associate director of the addiction division at Texas Southwestern Medical Center in Dallas, supported the new guidelines.

“Instead of depriving patients of the drugs they really need, we want more flexibility,” he said in an email. “Of course we have to be careful because opioid addiction is a serious problem. But this new approach will be a big help for patients who suffer from a lack of treatment.”

At least one group had hoped the guidelines would contain number caps in one of its bolder recommendations for drugmakers. In a March 25 letter, one of the most vocal critics of liberal opioid use, he advised that physicians may face “diminishing returns” for accountable opioid prescribing, the same 50-milligram cap of morphine as daily line regulators. This number is mentioned in depth in the guide.

As with previous guidelines, the new version recommends that caregivers try non-opioid approaches to pain management before starting the drug. It also suggests disparities in care for people of color, some of whom are less likely to see a pain specialist or receive a postpartum pain assessment than white people. Black people receive less pain medication than their white peers.

The new recommendations include advice on ways doctors and patients can discuss drug withdrawal. A warning that clinicians should “weigh the benefits and risks and use caution when changing opioid doses”; and “a reminder that they should regularly review the benefits and risks of ongoing opioid therapy with patients.”

“There’s no one-size-fits-all approach,” Jones said. “These are just guidelines.”

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