CDC Opens Draft Opioid Guidelines for Public Comment
The Centers for Disease Control and Prevention this month released its draft guidelines for the prescribing of opioid pain medications for chronic pain.
The recommendations are designed for primary care settings, and focus on chronic pain lasting longer than three months. They do not apply to palliative or end of life care. They were published on Dec. 14 and will be open for public comment until Jan. 13, 2016.
In its public notice the CDC stated, “The guideline is not a federal regulation; adherence to the guideline will be voluntary.” However, the American Medical Association and others noted that the guidelines would likely have significant public impact. For example, a new federal law requires the Veterans Administration to adopt the final CDC guidelines as official policy.
Here’s an outline of the CDC’s draft recommendations:
- Non-pharmacologic therapy and non-opioid pharmacologic therapy are “preferred” for chronic pain.
- Providers should establish treatment goals before starting opioid therapy for chronic pain.
- Providers should discuss the risks and “realistic benefits” of opioid therapy before starting opioid therapy, and periodically thereafter.
- Providers should prescribe immediate-release opioids for chronic pain, instead of extended-release opioids.
- Providers should start with the “lowest effective dosage.”
- For acute pain, providers should prescribe the “lowest effective dosage” for immediate-release opioids, and should prescribe “no greater quantity than needed for the expected duration of pain severe enough to require opioids. It states, “three or fewer days usually will be sufficient for most non-traumatic pain not related to major surgery.”
- Providers should evaluate the benefits and harms of with patients within 1 to 4 weeks of starting opioid therapy.
- Providers should evaluate risk factors for opioid-related harms before starting or continuing opioid therapy. These risk factors include the patient’s history of overdoses and/or history of substance abuse disorder.
- Providers should review the patient’s prescription history using the state prescription monitoring program when starting therapy, as well as periodically during therapy.
- Providers should use urine drug testing before starting opioid therapy for chronic pain, and should consider ordering such tests annually.
There have been strong reactions to the guidelines, focusing on both the content and the process under which the guidelines were developed.
The CDC did not originally plan to accept public comments before finalizing the guidelines, but the American Medical Association and other groups have criticized a “lack of transparency” in the drafting process.
An AMA letter to the CDC in October also stated the guidelines are “devoid of a patient-centered view and any real acknowledgement or empathy of the problems chronic pain patients may face.”
The House Committee on Oversight and Government Reform has also launched an investigation into the drafting process.
As of Dec. 30, the CDC’s website had collected more than 1,300 public comments. The AMA is expected to submit comments on the current draft in early January.