CDC Releases Guideline for Prescribing Opioids for Chronic Pain
March 16, 2016 -1:40 PM
As part of the U.S. government’s urgent response to the epidemic of
overdose deaths, the Centers for Disease Control and Prevention (CDC)
today is issuing new recommendations for prescribing opioid medications
for chronic pain, excluding cancer, palliative, and end-of-life care.
TheCDC Guideline for Prescribing Opioids for Chronic Pain, United States, 2016 will help primary care providers ensure the safest and most effective treatment for their patients.
The United States is currently experiencing an epidemic of
prescription opioid overdose. Increased prescribing and sales of
opioids—a quadrupling since 1999— helped create and fuel this epidemic.
“More than 40 Americans die each day from prescription opioid
overdoses, we must act now,” said CDC Director Tom Frieden, M.D., M.P.H.
“Overprescribing opioids—largely for chronic pain—is a key driver of
America’s drug-overdose epidemic. The guideline will give physicians and
patients the information they need to make more informed decisions
The guideline provides recommendations on the use of opioids in
treating chronic pain (that is, pain lasting longer than three months or
past the time of normal tissue healing). Chronic pain is a public
health concern in the United States, and patients with chronic pain
deserve safe and effective pain management. This new guideline is for
primary care providers—who account for prescribing nearly half of all
opioid prescriptions—treating adult patients for chronic pain in
outpatient settings. It is not intended for guiding treatment of
patients in active cancer treatment, palliative care, or end-of-life
While prescription opioids can be part of pain management, they have
serious risks. The new guideline aims to improve the safety of
prescribing and curtail the harms associated with opioid use, including
opioid use disorder and overdose. The guideline also focuses on
increasing the use of other effective treatments available for chronic
pain, such as nonopioid medications or non-pharmacologic therapies.
By using the guideline, primary care physicians can determine if and
when to start opioids to treat chronic pain. The guideline also offers
specific information on medication selection, dosage, duration, and when
and how to reassess progress and discontinue medication if needed.
Using this guideline, providers and patients can work together to assess
the benefits and risks of opioid use.
Among the 12 recommendations in the guideline, three principles are key to improving patient care:
Nonopioid therapy is preferred for chronic pain outside of active cancer, palliative, and end-of-life care.
When opioids are used, the lowest possible effective dosage should
be prescribed to reduce risks of opioid use disorder and overdose.
Providers should always exercise caution when prescribing opioids and monitor all patients closely.
“Doctors want to help patients in pain and are worried about opioid
misuse and addiction,” said Debra Houry, M.D., M.P.H., director of CDC’s
National Center for Injury Prevention and Control. “This guideline will
help equip them with the knowledge and guidance needed to talk with
their patients about how to manage pain in the safest, most effective
In developing the guideline, CDC followed a rigorous scientific
process using the best available scientific evidence, consulting with
experts, and listening to comments from the public and partner
organizations. CDC is dedicated to working with partners to improve the
evidence base and will refine the recommendations as new research
CDC will continue to work with states, communities, and prescribers
to prevent opioid misuse and overdose by tracking and monitoring the
epidemic and helping states scale up effective prevention and treatment
programs. CDC also continues to improve patient safety by equipping
health care providers with data, tools, and guidance so they can make
informed treatment decisions.
Health and Human Services Secretary Sylvia Burwell has made
addressing opioid misuse, dependence, and overdose a priority. Other
work on this important issue is underway within HHS. The evidence-based HHS-wide opioid initiative
focuses on three priority areas: informing opioid prescribing
practices, increasing the use of naloxone (a rescue medication that can
prevent death from overdose), and expanding access to and the use of
Medication-Assisted Treatment to treat opioid use disorder.
These efforts build on work that began in 2010, when the President
released his first National Drug Control Strategy, which emphasized the
need for action to address opioid misuse and overdose, while ensuring
that individuals with pain receive safe, effective treatment. Also in
2010, the Affordable Care Act improved access to substance use disorder
treatment options by requiring coverage of substance use disorder
services in the Health Insurance Marketplace and establishing important
parity protections to ensure that substance use disorder coverage is
comparable to medical and surgical care coverage. The next year, the
White House released its national Prescription Drug Abuse Prevention Plan
to outline goals for addressing prescription drug misuse and overdose.
Since then, the Administration has supported and expanded
community-based efforts to prevent drug use and pursue “smart on crime”
approaches to drug enforcement, as well as efforts to improve
prescribing practices for pain medication and increase access to
treatment, to reduce overdose deaths and support the millions of
Americans in recovery.
You don't have permmission to comment, or comments have been turned off for this article.