As part of the response for the increasing "epidemic of overdose deaths," the Centers for Disease Control and Prevention (CDC) issued new recommendations Tuesday for prescribing opioid medications for chronic pain, excluding cancer, palliative, and end-of-life care.
According to CDC, "While prescription opioids can be a part of pain management, they have serious risks." The "CDC Guideline for Prescribing Opioids for Chronic Pain – United States, 2016" aims at improving the safety of prescribing and curtailing the harms associated with opioid use, including opioid use disorder and overdose, while focusing on increasing the use of other effective treatments available for chronic pain, such as non-opioid medications or non-pharmacologic therapies. It will help the primary care providers in ensuring the safest and most effective treatment for their patients, while deterring the use of the medicines for chronic pain. It defines chronic pain as that which lasts longer than three months or past the time of normal tissue healing.
According to the release, the U.S. is experiencing an epidemic of prescription opioid overdose, created due to increased prescribing and sales of opioids, which have quadrupled since 1999.
"More than 40 Americans die each day from prescription opioid overdoses," stated Tom Frieden, M.D., M.P.H., Director of CDC. "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 about treatment," he said.
According to the CDC guidelines, when starting opioid therapy for chronic pain, doctors should prescribe immediate-release formulations instead of long-acting versions. "Long-term opioid use often begins with treatment of acute pain. When opioids are used for acute pain, clinicians should prescribe the lowest effective dose of immediate-release opioids and should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. Three days or less will often be sufficient; more than seven days will rarely be needed," the guidelines stated.
Moreover, clinicians should incorporate strategies to mitigate risk into the management plan, including considering offering naloxone when factors that increase risk for opioid overdose, such as history of overdose, history of substance use disorder, higher opioid dosages, or concurrent benzodiazepine use, are present.
While assessing the benefits and harms of opioid therapy, the agency said that more than 14,000 deaths in the U.S. in 2014 were due to overdose of prescription opioids.