The Centers for Disease Control and Prevention (CDC) recently issued new opioid prescription guidelines for pain patients. Some physicians welcome the change, while others are wary about prescribing these drugs, given the recent opioid epidemic.
The previous guidance for opioid prescriptions was released in 2016. In most instances, opioids were only given to palliative care and cancer patients. Although prescription opioid usage decreased significantly following the 2016 guidelines, pain patients were left with little recourse for pain management.
“We began to hear how the [2016] guidelines were being misused and misapplied,” said Christopher Jones, a co-author of the new guidelines.
Some of the changes to the guidelines include who can prescribe opioids, who can receive opioids, how long patients can receive opioid therapy, and recommended dosage. Although CDC guidelines are only recommendations, they are often widely adopted by physicians and treated as strict rules.
Previously, primary care physicians were the only ones recommended to prescribe opioids. Now, outpatient clinicians such as surgeons, neurologists, obstetricians, and dentists can prescribe opioids if necessary.
Dr. Bobby Mukkamala, a head and neck surgeon in Flint, Michigan, described the 2016 guidance as “disastrous for patients in pain.” Mukkamala said that, as a result of the guidelines, some pharmacists refused to fill prescriptions as doctors wrote them, pointing to the CDC’s suggested limits.
Additionally, in the 2016 guidance, clinicians were instructed to give opioids primarily to cancer and palliative care patients. However, doctors were recommended not to exceed 90 mg per day.
The CDC has removed the specific maximum dosage recommendation of 90 milligrams in the updated guidelines.
Instead, the CDC stated, “The recommendations related to opioid dosages are not intended to be used as an inflexible, rigid standard of care; rather, they are intended to be guideposts to help inform clinician-patient decision-making.”
Moreover, CDC guidelines no longer have a three-day pain opioid prescription limit. The new guidance extends opioid treatment to those who experience acute (less than 30 days) and subacute (1-3 months) pain. However, the CDC states that clinicians should discuss the “alternatives to opioids before starting or continuing opioid therapy.”
For patients receiving long-term opioid therapy, the CDC recommends that doctors taper dosages down when they feel opioids are no longer beneficial for long-term patients, noting that discontinuing treatment altogether can cause rapid withdrawal, which can lead to severe injury or death.
The Morbidity and Mortality Weekly Report issued by the CDC states that one in five adults deals with chronic pain.
However, the CDC still recommends that “all patients with pain should receive treatment that provides the greatest benefits relative to risks,” and whenever possible, clinicians should seek “nonopioid options” first.
Opioid deaths reached their peak in 2011, quadrupling 1994 statistics. In 2011, doctors wrote enough prescriptions to give every adult American 74 pills. Since 2011, doctors have cut opioid prescriptions in half.
Dr. Adriane Fugh-Berman of Georgetown University Medical Center attributes the low number of prescriptions to the apparent success of the 2016 guidelines. She feels the new guidelines are inappropriate in the wake of the opioid crisis.
“There was nothing wrong with the original guidelines,” said Fugh-Berman to the Associated Press.
Allen Frances, a professor Emeritus of Psychiatry at Duke University, said he initially thought the 2016 guidelines would be helpful. However, he claimed that the recommendations actually resulted in patients being thrown “from the oxycontin frying pan into the fentanyl fire.”
In 2021, opioid deaths increased by 15% from 2020, the CDC reported. As a result, opioids claimed the lives of an estimated 107,000 Americans. However, 70% of the fatalities resulted from synthetic opioids such as fentanyl.
“Oxycontin created a deadly opioid epidemic. Heroin used to be the world’s most dangerous street drug and for 50 years defeated all the futile efforts of the ‘war on drugs’. But fentanyl is the real monster — impossible to interdict, capable of real mass murder,” wrote Frances.
