By Jacob Molyneux, senior editor
The CDC’s new Guideline for Prescribing Opioids for Chronic Pain was released this week. The context for this comprehensive new guideline is widespread concern about opioid-related overdose deaths and substance abuse in the U.S.
The guidelines make 12 main recommendations, among them the following:
- nonpharmacologic or nonopioid pharmacologic treatments should be considered “preferable” first-line therapy for those with chronic pain.
- a daily opioid dosage limit of morphine milligram equivalents should be imposed.
- immediate-release opioids should be prescribed before moving to extended-release formulations.
- urine testing should precede new opioid prescriptions for chronic pain and treatment goals should be set.
- clinicians should prescribe the lowest possible number of days’ worth of medication for acute pain (often three days or less).
- prescription drug monitoring program (PDMP) databases should be consulted to determine patients’ past histories of opioid prescriptions.
Some of the recommendations would seem to be no-brainers, such as consulting PDMPs when writing new prescriptions. Others, such as a “one-size-fits-all” daily dosage limit and restrictions on the use of extended release formulations, have raised alarms among pain management experts. See, for example, “I’m Worried About People in Pain,” a recent AJN Viewpoint essay by Carol Curtiss, a nurse and pain management expert, who notes the increased stigmatization experienced by pain patients and the chilling effects of new restrictions on doctors’ prescribing, to […]