The guidelines target primary care clinicians who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care. Clinicians should only continue opioid therapy if there is a clinically meaningful improvement in pain and function that outweighs risks.
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The Centers for Disease Control and Prevention on Tuesday released final guidelines warning doctors to be more cautious about prescribing opioids to adults as concern grows over the abuse of painkillers across the country.
“It’s a way to find out what level of opioids the patient might already be on”, Becky Vaughn, vice president of addictions at the National Council for Behavioral Health, who is familiar with the guidelines, said in an interview.
The role of pharmaceutical companies in encouraging the growth in opioid prescribing is also contentious. The rate of drug overdose deaths from opioids, including prescription painkillers and heroin, tripled between 2000 and 2014, and deaths from opioid painkillers alone rose 9% in 2014, according to the CDC. So can other medications, like acetaminophen or ibuprofen.
SOURCES: March 15, 2016, news conference, with Tom Frieden, M.D., director, U.S. Centers for Disease Control and Prevention; March 15, 2016, news releases, U.S. Centers for Disease Control and Prevention and Journal of the American Medical Association; Harshal Kirane, M.D., director, addiction services, Staten Island University Hospital, New York City; Ashish Sahasra, D.M.D., endodontist, Premier Endodontics, Garden City, N.Y.
With 40 people dying every day from prescription opioid overdoses, CDC Director Thomas Frieden, MD, MPH, said the time to act is now. “It is so important that doctors understand that any one of those prescriptions could potentially end a patient’s life”.
CDC officials stressed that in many cases, opioid drugs do not lessen pain as well as other therapies, such as anti-inflammatory drugs or, in some cases, exercise. Patients with acute pain, such as that caused by an injury, usually don’t need prescription opiates more than three days. Sue Walker, who was diagnosed with fibromyalgia two decades ago, takes opioid pain medications daily and said she feared doctors would stop prescribing drugs to people who depend on them.
“The prescription overdose epidemic is doctor-driven and can be reversed, partly, by doctor actions”, Frieden said in a press conference.
“Widespread adoption of the CDC’s recommendations in clinical practice would help reverse the epidemic of opioid overprescribing”, Yngvild Olsen of the Institutes for Behavior Resources, Inc.in Baltimore wrote in an editorial accompanying the new guidelines.
The CDC said it is aiming the new guidelines at primary care physicians, because those doctors now write almost half of all prescriptions for narcotic painkillers.
CDC says deaths from opioid overdoses have hit an all-time record in the U.S.
What it does have is 12 recommendations – chief among them that opioids shouldn’t be used as first-line therapy in chronic pain, because there is no evidence that they work for long-term chronic noncancer pain.
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.
Well, I think there is weakness [in evidence] on the benefits of opioids but there’s been significant progress on the risk of opioids.
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Consider other ways to manage pain.
