CDC warns "misapplication" of its opioid guidelines for the treatment of chronic pain

The Centers for Disease Control and Prevention issued a press release in which they discouraged what it calls "misapplication" of its 2016 "Guidelines for the Prescription of Opioids for Chronic Pain".

The statement states that the recommendations do not apply to patients with cancer or palliative care, those who are treated for an opioid use disorder and that "policies that impose limits Strictly contrary to the focus of the Guideline on an individualized assessment of the benefits and risks of opioids according to the unique circumstances and needs of each patient. "

"The CDC applauds the efforts of health care providers and health systems, quality improvement organizations, payers and states to improve opioid prescribing and reduce misuse and abuse. opioid overdoses, "reads the statement.

"However, some policies and practices that cite the guideline are inconsistent with its recommendations and go beyond that."

The April 24 statement was published at the same time as the New England Journal of Medicine published a related Perspective article entitled "No Shortcut to Safer Prescription for Opioids."

The guidelines and their application have been criticized by pain specialists, in particular, who have stated that recommendations to combat opioid misuse have had "terrible" unintended consequences for patients with chronic pain who have no addiction problem and long-term prescription treatment. opioids.

More than two dozen states have enacted legislation setting limits on opioid prescriptions based on what the CDC has formulated as a voluntary reference for primary care physicians.

The CDC statement states that the guideline "was developed to ensure that primary care clinicians work with their patients to consider all safe and effective treatment options for pain management."

"The CDC encourages clinicians to continue to use their clinical judgment, to base treatment on what they know about their patients, to maximize the use of safe and effective non-opioid therapies, and to consider" Use of opioids only if their benefits outweigh their risks. ," it is said.

The CDC stated that it "raised awareness of the following issues that could put patients at risk":

• Misapplication of recommendations to populations outside the scope of the Guideline. The guideline is intended for primary care clinicians treating chronic pain in patients 18 years of age and older. Examples of misapplication include the application of the guideline to patients on active cancer therapy, patients with acute attacks of sickle cell disease or patients with postoperative pain.
• Misapplication of the guideline guideline guideline that results in strict limits or reduction of opioids. The guideline says:When opioids are startedclinicians should prescribe the minimum effective dosage. Clinicians should … avoid increasing dosage greater than or equal to 90 MME / day or carefully justify a decision to titrate the dosage up to ≥ 90 MME / day. The statement of recommendation does not suggest discontinuation of opioid therapy already prescribed at higher doses.
• Guideline does not support phasing out or sudden cessation of opioids. These practices can lead to severe symptoms of opioid withdrawal, including pain and psychological distress, and some patients may search for other sources of opioids. In addition, policies that impose strict limits run counter to the focus of the Guideline on the individualized assessment of the benefits and risks of opioids, given the specific circumstances and specific needs of individual patients.
• Misapplication of recommendation recommendation to patients receiving or starting treatment with opioid drug therapy.The recommendation in the Dose Guideline applies to the use of opioids in the treatment of chronic pain, and not to the use of drug-assisted treatment for opioid disorder. The guideline strongly recommends that medication-assisted treatment be provided to patients with opioid use disorder.