great article. a huge topic that needs much attention
CDC Issues New Guidelines for Opioid Prescribing — Physician’s First Watch
CDC Issues New Guidelines for Opioid Prescribing
By Kelly Young
Edited by Lorenzo Di Francesco, MD, FACP, FHM
The CDC has issued 12 new recommendations for clinicians prescribing opioids for pain outside of cancer treatment or palliative care. The full guideline is published in MMWR.
Among the recommendations:
For chronic pain, the first choices of treatment should be nonpharmacologic or nonopioid. Opioids should be an option only if the expected pain and function benefits outweigh the potential risks.
Patients starting opioids should be prescribed immediate-release opioids at the lowest effective dose, not extended-release/long-acting opioids.
Individual benefits and risks should be reassessed when increasing the dosage to 50 morphine milligram equivalents (MME) or more per day. Dosages of 90 MME or more should be avoided, or clinicians should "carefully justify a decision" to increase the dosage to that level.
For acute pain, an opioid prescription for 3 days or fewer will often be enough. More than 1 week is rarely needed.
Clinicians should regularly evaluate risk factors for opioid-related harms (e.g., history of overdose or substance use disorder) and consider offering naloxone to high-risk patients.
Concurrent prescriptions of opioids and benzodiazepines should be avoided.
Reader Comments (3)
From my experience, the guidelines could be much shorter "Do not use opioids for chronic pain". Opioids worsen chronic pain and function, and leave people with opioid induced brain changes within weeks of chronic use. The prescribed opioid harm epidemic is very helpful to promote awareness that we physicians must be careful to avoid conflicts of interest, including taking lunches, honoraria, talks, etc from drug companies, which largely promoted the false ideas that opioids are effective, non-addictive, and safer than alternatives for chronic pain. The past 20 years have shown none of these messages are true.
Ultimately, this stacks up as "evidence." When we defend practitioners, a provider must be able to defend "the match." If the patient requires X pills per day, 30X, per month, then it has to be correct...10,000 pills are indefensible. Perfect clinical documentation is crucial. A provider may depart from the guidelines only when he is able to justify doing that on a legitimate CLINICAL basis. If a practitioner is contacted about an investigation, DO NOT participate without a KNOWLEDGEABLE and EXPERIENCED lawyer.