CDC: Think long and hard before prescribing opioids for chronic pain

CAL/AAEM News Service calaaem.news.service1 at gmail.com
Tue Mar 22 17:33:16 PDT 2016


       

 

March 15, 2016

 

CDC: Think long and hard before prescribing opioids for chronic pain

 

 

 
<http://www.fiercepracticemanagement.com/story/new-cdc-guidelines-for-prescr
ibing-opioids-for-chronic-pain/2016-03-15?utm_medium=nl&utm_source=internal&
mrkid=%257B%257Blead.Id%257D%257D&mkt_tok=3RkMMJWWfF9wsRonvqjNc%252B%252Fhmj
TEU5z14uwoXKW%252BlMI%252F0ER3fOvrPUfGjI4ARMBhN6%252BTFAwTG5toziV8R7LMKM1ty9
MQWxTk> Fierce Practice Management

 

 

By Julie Bird

 

Trying to curb widespread opioid abuse that claimed nearly 20,000 U.S. lives
last year alone, the Centers for Disease Control and Prevention (CDC) is
telling primary care clinicians to prescribe treatments other than opioids
for chronic pain outside of active cancer treatment, palliative care and
end-of-life care.

 

The new CDC opioid prescription guidelines are intended for use outside of
acute care settings.

 

A Special Communication from the CDC published online in the Journal of the
American Medical Association (JAMA) outlines 12 recommendations divided into
three categories.

 

They are:

 

Determining when to initiate or continue opioids for chronic pain:

 

1. Consider opioid therapy only if expected benefits for both pain and
function are expected to outweigh risks to the patient.

2. Establish treatment goals with all patients, including realistic goals
for pain and function, and consider how to discontinue therapy if risks
outweigh benefits.

3. Discuss risks and realistic benefits of opioid therapy with patients, as
well as patient and clinician responsibilities for managing therapy.

 

Opioid selection, dosage, duration, follow-up and discontinuation:

 

4. At the beginning of opioid therapy for chronic pain, prescribe
immediate-release opioids instead of extended-release/long-acting opioids.

5. Prescribe the lowest effective dosage and use caution when prescribing
opioids at any dosage. Carefully reassess benefits and risk when increasing
dosage to 50 morphine milligram equivalents (MME) or more per day and avoid
increasing dosage to 90 MME or more per day.

6. Limit opioid prescriptions for acute pain--more than seven days' worth is
rarely needed.

7. Evaluate benefits and harms with patients as early as one week and no
more than four weeks after starting therapy for chronic pain or escalating
doses, and again after no more than three months. Taper dosages or
discontinue opioids if necessary.

 

Assessing risk and addressing harms of opioid use:

 

8. Incorporate into the opioid therapy management plan strategies to
mitigate risk, including considering offering naloxone when factors that
increase risk for overdose are present.

9. Use state prescription drug monitoring program (PDMP) data to see whether
a patient is getting opioids from other providers at dosages or in
combinations with other drugs that create a high risk of overdose. 

10. Order urine drug testing before starting opioid therapy and consider
repeating at least annually.

11. Avoid prescribing opioid pain medication and benzodiazepines at the same
time whenever possible.

12. Offer or arrange evidence-based treatment for patients with opioid use
disorder.

 

A companion commentary in JAMA contends that part of the problem is that
doctors aren't well trained about addiction either in medical school or in
continuing education. It also cites "enormous gaps in reimbursement" for
both chronic pain and addiction treatment.

 

"The CDC guideline for prescribing opioids for chronic pain is an important
and essential step forward," it says. "With support from physicians across
the country, as well as from policy makers at all levels, implementation of
the recommendations in this guideline has the potential to improve and save
many, many lives."

 

Just last month the American Medical Association issued its own suggested
changes for practitioners to tackle the opioid addiction crisis, as
FiercePracticeManagement reported. Like the CDC, the AMA recommended
clinicians use PDMP data routinely. 

 

As the CDC notes in its new guidelines, primary care clinicians can help
avert possible abuse by communicating with patients before prescribing
opioids to learn about any personal or family history of addiction, and to
determine whether patients even want opioid painkillers,
FiercePracticeManagement previously reported.

 

 

 

Jeff Wells
Deputy Editor, CAL/AAEM News Service

 

Brian Potts MD, MBA
Managing Editor, CAL/AAEM News Service



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