Centers for Disease Control Opioid Guideline Has Been Misapplied

The U.S. Centers for Disease Control and Prevention (CDC) is clarifying its guideline on opioid prescribing to address the findings of a multidisciplinary panel that determined health care professionals and policymakers have been misapplying the guideline. The CDC’s report, “No Shortcuts to Safer Opioid Prescribing,” published in the New England Journal of Medicine, addresses several of the panel’s concerns for prescribing clinicians who treat patients with chronic pain.

In the study, “Challenges With Implementing the Centers for Disease Control and Prevention Opioid Guideline: A Consensus Panel Report,” published in Pain Medicine, experts identified several challenges associated with the implementation of the CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016.

Published in response to the increase in opioid misuse, the recommendations were intended to help identify risks associated with long-term opioid therapy, improve communication between clinicians and patients on the benefits and risks of opioid use for chronic pain, and improve the effectiveness of pain management methods. However, the panel determined some clinicians are treating these recommendations as hard-and-fast rules by enforcing hard limits on opioid doses and abruptly tapering or stopping opioid prescriptions. Clinicians are also misapplying recommendations to populations outside of the guideline’s scope, including individuals in active cancer treatment.

Challenges also include inflexible application of recommended dosage ceilings and prescription durations, availability of multimodal pain care, and failure to include patients in the decision to taper or discontinue opioids. The CDC is evaluating the impact of the guideline on prescription practices and outcomes, and recommendations will be updated once new evidence is available.

From Decisions in Dentistry. July/August 2019;5(7):10.