CDC Opioid-Prescribing Guideline for Chronic Pain: Concerns and Contexts
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 […]