CDC proposes loosening guidelines on chronic pain patients, opioid prescriptions

Practice Management

The CDC has proposed new guidelines for prescribing opioid painkillers that would remove its previous recommended ceilings for chronic pain patients and encourage physicians to use their best judgment, according to The New York Times.

The agency's proposal, issued Feb. 10, advises physicians to prioritize nonopioid therapies for chronic and acute pain, such as prescription and over-the-counter medications, physical therapy, massage and acupuncture.

According to the CDC, its previous guidance, issued in 2016, helped slow the prescribing that ignited the opioid epidemic, but it also led to some physicians cutting off patients taking prescription painkillers too quickly and keeping opioids from patients who may benefit.

Dangers of opioids — including addiction, depressed breathing and altered mental state — are outlined in the proposal, but it also notes their benefits, particularly for easing the acute pain from traumatic injuries such as burns and crushed bones. In such instances, physicians are advised to begin with the lowest effective dose and prescribe immediate-release pills over long-acting ones.

Proposed changes would walk back some suggested limits on opioids with the intention of fostering more individualized patient care and offer more options for the treatment of short-term, acute pain resulting from surgeries or injuries, according to the report. The guidelines do not apply to patients suffering pain from cancer or sickle cell anemia, or are in end-of-life or palliative care.

Other changes include: no longer suggesting limiting opioid treatment for acute pain to three days; dropping the recommendation that physicians avoid upping dosage to a level equivalent to 90 mgs of morphine per day; and advising physicians to not abruptly halt treatment for patients receiving higher doses of opioids unless there are indications of life-threatening danger.

The recommendations are open on the Federal Register for public comment for 60 days. Like the 2016 protocols, the guidelines would be suggested practices and not mandatory.

The CDC will review comments and is expected to issue a final version by year's end.

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