February 10, 2022
3 min read
Source/Disclosures
Disclosures:
Gupta reports serving as an adviser to the FDA and Milken Institute Faster Cures and being a board member of HealthyWomen and the U.S. Department of Defense. Jones reports no relevant financial disclosures.
The CDC released a draft of its updated guidelines for prescribing opioids, which emphasize patient-centered decisions and would reduce some limitations on prescribing that were previously set in 2016.
The draft guidance was released amid an increase in opioid-related deaths in the U.S. According to a recent report published in The Lancet, the incidence of fatal opioid overdoses in the U.S. increased 37% from 2019 to 2020.
The 12 recommendations included in the draft guidance, which come from the CDC’s National Center for Injury Prevention and Control, are voluntary and not intended as “inflexible standards of care” or a replacement for clinical judgment or patient-centered care, the CDC wrote in a press release.
The agency advised clinicians to “collaborate with patients when making treatment decisions and designing a treatment plan.”
“It is important that amidst a rising opioid crisis and global pandemic, we continue to focus on patient-centered policies and equitable innovation,” Anita Gupta, DO, PharmD, MPP, a Healio Primary Care Peer Perspective Board member and faculty member in the departments of anesthesiology and critical care at Johns Hopkins School of Medicine, told Healio.
Anita Gupta
CDC officials said the agency’s 2016 opioid guidelines, which recommended restrictions on prescribing, led to a reduction in prescriptions but also prompted some providers to avoid prescribing opioids to patients who may have benefited from them, according to the Associated Press. Out of consideration of the “constant tension” that followed the 2016 guidelines, the CDC proposed removing certain opioid dosage ceilings. Specifically, the draft guidance does not state that physicians should avoid increasing the dosage to a level equivalent to 90 mg of morphine per day. The working group that reviewed the draft recommendations reported that “specific opioid doses would be misapplied as absolute cutoffs or thresholds for policies or practices.”
Prior to prescribing opioids to patients, the draft guidance states that physicians should consider toxicology testing to determine whether the patients are using other controlled and illicit drugs. However, the CDC did not recommend requiring having such tests done annually.
For patients already receiving opioid therapy, the draft guidance advises physicians to work with them to incorporate risk mitigation strategies to avoid overdose or misuse. Also, the draft guidance discourages sudden discontinuation of opioids, especially for patients on high-dose opioid therapy, unless it is a life-threatening situation.
In addition, the CDC stated in its draft guidance that nonopioid therapies are preferred as first-line treatment for acute, subacute and chronic pain. Opioid therapy should only be considered when the expected benefits of its use outweigh the risks.
The draft guidance does not apply to inpatient care in a hospital or ED setting but does extend to prescriptions made at discharge. It is accessible on the Federal Register and open to public comment for 60 days. The CDC will consider the comments before deciding on its final updated recommendations, which the agency expects to release at the end of 2022.
“This comment period provides another critical opportunity for diverse audiences to offer their perspective on the draft clinical practice guideline,” Christopher M. Jones, PharmD, DrPH, MPH, the acting director for the National Center for Injury Prevention and Control, said in the release. “The ultimate goal of this clinical practice guideline is to help people set and achieve their personal goals to reduce their pain and improve their function and quality of life. Getting feedback from the public is essential to achieving this goal.”
References:
CDC proposes softer guidance on opioid prescriptions. https://apnews.com/article/science-health-centers-for-disease-control-and-prevention-public-health-opioids-a9d11248e8ec97170df19a9fc9da2bbc. Published Feb. 10, 2022. Accessed Feb. 10, 2022.
Draft CDC clinical practice guideline for prescribing opioids. https://www.regulations.gov/document/CDC-2022-0024-0002. Published Feb. 10, 2022. Accessed Feb. 10, 2022.
Humphreys K, et al. Lancet. 2022;doi.org/10.1016/ S0140-6736(21)02252-2.
OWG report with CDC response draft clinical practice guideline. https://www.regulations.gov/document/CDC-2022-0024-0004. Published Feb. 10, 2022. Accessed Feb. 10, 2022.
Proposed 2022 CDC clinical practice guideline for prescribing opioids. https://www.federalregister.gov/documents/2022/02/10/2022-02802/proposed-2022-cdc-clinical-practice-guideline-for-prescribing-opioids#h-2. Published Feb. 10, 2022. Accessed Feb. 10, 2022.
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