On Tuesday, the Center for Disease Control issued new federal guidelines on the prescribing of opioids by primary care physicians, specifically for patients that do not fall into the categories of end-of-life, cancer, and palliative care. The guidelines mark the work of nearly 24 months of work by governmental agencies (both federal and state), advocacy organizations (such as Hazelden Betty Ford’s Institute for Recovery Advocacy), industry experts, and individual stakeholders.
Though opponents of the guidelines express frustration that the guidelines were developed in a manner inconsistent with desired transparency, the CDC engaged in a rigorous methodology throughout the development process. Described in detail in the guidelines summary, the “CDC obtained input from experts, stakeholders, the public, peer reviewers, and a federally chartered advisory committee”. The divisiveness of the guidelines could be seen as public comment was allowed from December 2015 through January 2016, with staunch opponents afraid that the guidelines would negatively impact those suffering from chronic pain, otherwise unmanageable by alternative treatments. However, as mentioned multiple times throughout the guidelines, this cross-section are not the target of the non-binding federal guidelines, rather those with chronic pain not associated with the excluded treatment types (active cancer, palliative, and end-of-life care) that have yet to try alternative methods.
For those that have tried alternative methods, with no avail, the guidelines set forth recommendations to mitigate the risk of mild to severe opioid use disorder including urine drug tests before and during opioid therapy, the use of prescription drug monitoring programs (ironically, though 49 states have a type of PDMP, only 16 actually mandate their use – from a policy perspective, hopefully the new guidelines will impact modifications of state legislative action here), assessment of risk of development of a substance use disorder, prescribing 3-7 days of opioids for acute pain at the lowest dose possible, utilizing only immediate-release opioids rather than extended or gradual release, amongst others.
The guidelines go further to clearly delineate out the need for initial assessment and constant reassessment to weigh the benefits and risk for utilizing opioid therapy in the treatment of pain. The CDC has worked diligently to address the ever-growing public health crisis in this country, and done so in a manner that shows proper due diligence and transparency for all patient populations. The guidelines will hopefully spark an increase in education for primary care physicians which prescribe opioids, and further promote policy level dialogue around the treatment of chronic pain, and the role prescription opioids play in our medical treatment communities.