The new guidelines come on the heels of the controversial 2016 guidance that placed hard caps on prescribing.
Clinical judgement should prevail when it comes to opioid prescribing, according to new draft update of guidelines released by the CDC.1
The 2022 guideline is aimed at primary care and other clinicians who manage pain in an outpatient setting, and for those discharging patients from EDs. The draft guidance includes 12 recommendations focused on 4 key areas:
Helping clinicians determine whether or not to initiate opioid treatment for pain. Opioid selection and dosage. Duration of use and follow-up. Assessing risk and addressing potential harms from use.
The update comes on the heels of controversial guidance released by the CDC in 2016. Although the 2016 guidelines intended to help quell rampant opioid abuse in the United States, critics of the guidelines say they had a swift and significant chilling effect on opioid prescribing, leaving health care professionals leery of providing the drugs for pain of almost any severity and some patients with chronic pain cut off from prescriptions they may have taken for years.
Authors of the original guidance2 have maintained that the recommendations were misapplied and even wrongly used in some states by medical boards to sanction clinicians who exceeded what were interpreted as opioid prescribing ceilings.
CDC states that the recommendations are voluntary. They are intended as flexible standards of care and not meant to replace clinical judgment or individualized, patient-centered care. The draft guidance still advises clinicians to limit new opioid prescribing, eg, for acute injuries, and to consider alternative therapies first, saying “opioids should not be considered first-line or routine therapy for subacute or chronic pain.” The authors state that non-opioid medications and interventions like exercise and physical should be prioritized.
But this version does not include hard cutoffs for opioid dosage or length of prescriptions and has removed recommendations that clinicians “avoid increasing dosage” to 90 morphine milligram equivalents or more per day, or, if necessary, to “carefully justify” the decision.
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