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CDC Loosens Opioid Guidelines

CDC Loosens Opioid Guidelines
Oxycodone Prescription | Image by Shutterstock

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.

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17 Comments

  1. Bret

    Who really wants to trust anything from CDC

    Reply
  2. Melody

    It’s about time!! It’s pretty bad when the only solution to controlling chronic severe pain is going to the streets for fentanyl.

    Reply
    • Joy Neill

      So very true Unfortunately that’s the only way you can get a pain pill it’s ridiculous. They made this at the same as I made up everything else shame on

      Reply
  3. Sam Flores

    Send memos to doctores that its ok to prescribing pain meds to th oes that need it.

    Reply
  4. Leon

    The CDCS are forcing doctors to cut back on prescribing Opioids to patients who really need this kind of pain relievers, but what are the options are after all ? ?
    patients who’s suffer from chronic pain what they would do ? ., since doctors and pharmacists are being threatened by CDCS to cancel or suspend their licenses if they continue prescribing opioids.

    Reply
  5. Dorothy

    I was living a normal life with hydrocodone…for over 15 years. After having to stop cold turkey due to the CDC, I have had 9 back injections, 1 neck injection, and have gained weight and am able to do only the basic activities. Except working.The alternatives are just not working.

    Reply
  6. Uschi

    Being in the pain management field for 25 years,I saw chronic pain patients suffer tremendously.To just thrown everybody under one blanket,never works ! It took years to determine the dosage for chronic pain,then it was just reducing pain medication.The 90 mg a day limit a day doesn’t work for everybody.I hope with the new guidelines chronic pain patients have a life again.

    Reply
    • Geo

      I suffered from intense chronic pain for five years with intense chronic pain from necrotizing bone. Thankfully I went to a pain management doctor, an anesthesiologist by specialty, and it required active management of dosage and periodic medication rotation of narcotics to limit increasing tolerance. Even so, the doctor failed to follow NIH drawdown guidelines when I healed and the time came to stop. The opioid crisis was in large part caused by lowering the classification of Norco type combination, ready availability and over-supply of the narcotics combined with Big Pharma promotion and disinformation. No set limits are appropriate but no physician should prescribe narcotics without extensive education, experience and a willingness to actively manage the narcotics use.

      Reply
  7. J hh

    Try kratom … works wonders for some people given the right strain, not for everyone but if your willing to use opioids then a botanical can’t hurt

    Reply
    • J hh

      It really relieves almost all pain without inebriating you

      Reply
  8. Linda Amaro

    I suffer every day with pain. I have sciatica nerve damage in my back and bone on bone and can’t get anything for my pain that I have to live with everyday.

    Reply
    • Craig Takach

      Im in the same predicament!! I was in a terrible wreck at the hands of a drunk driver!! Five joint replacements, a broken back in three places and numerous other surgeries stemming directly from that wreck!! The most my doctor prescribes is 3- 5 mg. oxycodone per day! Damn shame the doctors or CDC can’t feel the pain I’m in all day,every day!! The CDC as well as the doctors should be ashamed at thereselves! Live one day in my pain and I guarantee you’d prescribe yourselves opiates quickly! SMDH!!!

      Reply
  9. Marivel Fernandez

    I’ve had Colon Cancer at age 23yrs old I’m 51yrs old now had 41 surgeries do the math, live with Chronic pain , Scar tissue and adhesions 2in of colon left ,17ft intestines removed, Full hysterectomy gone, Gallbladder,Appendix gone, I’m in pain daily like contractions with no child,patients who really need stronger pain killers to function for the day that don’t abuse it ,who really need them, we can’t receive them and go to ER almost every week be treated like we are Junkies it’s Horrible way to live, I don’t wish this upon anyone,my pains everyday a scale from 0-10 I’m a 8 and when it hurts badly over a 10, mind over matter and resilience go out the door, I would love to have this opioids restrictions to change for us who really need them.

    Reply
    • Joy Neill

      So very sorry God bless you

      Reply
  10. Deana

    I agree with the cdc is not t doctors fault by no means from one generation to the next that’s how they were taught to deal w a person in chronic pain however to just cut a Preston off is not the answer I was a patient for 23 years n one day my life went upside down I do belive it was 2016 out 17 I almost died had I not had a daughter whom is in recovery now for 7 years I wouldn’t be here to tell my story tho I live w chronic pain daily due to the fact I can not find proper care as today they’d generalize me as an addiction is not my mind rather my body doesn’t function properly wo opioid after 23 years then nothing I feel my heart my blood pressure my over all well being being cut short!! What needed to be done by these said doctors was take as needed not this is what your going to take n should your urine or blood screens show different your cut off I thought o was doing good not taking so many I was prescribed 320 of one type n140 of another what happened when I stopped hallucinations seizures it was a great mess where is if while in pain management I were to told take as needed I feel I would have done a lot better than to be told I had to take 320 of one type and 140 of another to nothing that created a monster Within Me that I had no idea what was happening however my daughter knew exactly what it was and that’s a shame that a doctor didn’t take into consideration what was going to happen to his patient and what happens daily to this patient for the rest of my life it is a true struggle

    Reply
  11. Pap

    The government is interfering in patient care by handcuffing their doctors. Your doctor is the one who actually SEES you, not some bureaucrat. Patients should be warned of the dangers and use common sense in taking the med. If some patients are going to ignore the warnings and overdose, not much you can do about that. Those people might take a whole bottle of aspirin. It is totally unfair and cruel to try to severely limit and control medicine for people who are in dire need because of people who choose not to listen. People just need to be responsible for their choices.

    What other people do should not rule my life.

    Reply
    • Joy Neill

      I believe they want you to go to the streets so you can die They don’t want us to live. Everyone knows street drugs are fentanyl or laced ,if you’re a drug addict you’re going to be a drug attic so help those who need it God

      Reply

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