• The CDC has issued new guidelines for prescribing opioids.
  • The new guidelines come as opioid-related overdoses have hit record highs.
  • Experts have been trying to balance the needs of patients with chronic pain against the risk of addiction.

​The US Centers for Disease Control has updated its guidelines for clinicians in prescribing opioids – the first update since 2016.

These guidelines come from the organization as 12 recommendations for clinicians in prescribing opioids for acute, subacute, and chronic pain and address some of the shortcomings of the 2016 recommendations.

“Following the release of the CDC guidelines in 2016, the pendulum for opioid prescribing swung from liberal to very strict,” Dr. Rebecca Donald, Assistant Professor of Anesthesiology and Pain Medicine at Vanderbilt University Medical Center in Nashville, Tennessee.

Donald explained that “while intended to be used as guidelines in conjunction with clinical judgment, many practitioners treated the 2016 document as if it were law.”

However, one consequence was that those people who had been on these medications for years or used these medications for pain relief had sudden reductions in their medications and sometimes turned to non-prescribed means of obtaining these medications including off the street.

Some experts believe that because of the strict guidelines, some patients unfairly dealt with pain while others tried to find pain relief through non-prescription methods including illegal drug use.

The newly updated guidelines work to understand dependence, prevent unintended deaths, and promote other forms of pain control by working with a patient’s physician.

These guidelines break down their advisories into “Category A” and “Category B” recommendations.

Category A advisories apply to all individuals and indicate actions that can be followed in most circumstances. Category B recommendations indicate that the advisory may not apply to all individuals so decisions should be made based on a patient’s circumstances with a physician.

One strong Category A recommendation is for those suffering from subacute and chronic pain. Patients with this type of pain, or those individuals with pain lasting for over one month, should be treated with non-opioid therapies as a preferred method.

Similarly, the guidelines advise clinicians to work with patients in prescribing opioids for acute pain as a Category B recommendation. This allows for conversations with clinicians and their patients in making the right decision about opioids – moving away from the stricter guidelines from 2016.

Addiction, dependence, and tolerance are considered the biggest concerns when taking opioids – particularly in those patients who are taking them for a longer period.

“Patients who might need opioids should understand that a prescribed opioid does not typically lead to addiction,” says Dr. Stefan Kertesz, professor at the Heersink UAB School of Medicine, a researcher at the Birmingham Alabama Healthcare System, and board certified in internal and addiction medicine.

While there are a few reasons why people get addicted, Donald explains that genetic factors, including relatives with a history of alcohol or other substance abuse and those with adverse childhood experiences such as childhood trauma or unstable family life, are a few factors that can lead to a possible dependence on these medications.

“Unfortunately, addiction is highly stigmatized and is seen as a moral failing rather than the complicated disease that it is,” explained Donald. “This stigma is one of the main reasons that people with substance use disorders do not seek treatment, and it is contributing to the ongoing rise in opioid-related overdose deaths.”

Kertesz suggests “before considering opioids, the right conversation to demand is “right now, do the projected benefits outweigh the risks for me?”

This new 2022 update also comes on the heels of a recent spike in drug overdoses – with most deaths associated with non-prescription drugs.

Before the 2016 guidance, opioid prescribing was already steadily decreasing with a peak of about 263 million prescriptions in 2012 and about 144 million prescriptions in 2020.

Despite opioid prescribing currently being the lowest since the mid-1990s, death rates from opioids still increased – and likely due to the use of synthetic opioids – particularly fentanyl which has increased since 2013.

“Provisional data for the 12-month period ending May 2022 [predicted] 81,540 deaths involving opioids of some kind, overwhelmingly involving illicitly manufactured fentanyl and its derivatives,” Kertesz told Healthline.

Kertesz believes that the number of deaths will rise above 100,000 by the end of 2022.

Despite this new guidance from the CDC, it should be noted that these are recommendations and are not mandatory practices. The CDC recognizes that there should be some flexibility with the prescription use of medication and should not be a one-size-fits-all policy.

Instead of using the 2016 guidelines which were served to immediately cut down the number of opioids, the new guidelines have a more understanding approach when addressing pain and allow physicians to have these conversations with their patients and decide together.

“The unintended consequences of the previous guidelines have become apparent, and it is the hope that the new guidelines will shift the focus from rules and numbers to more shared decision making by physicians and their patients,” Donald told Healthline.

Experts say prescribing and understanding the effects of opioids is more complex than just dispensing medications and stopping them when a physician feels they have been overused.

Dr. Rajiv Bahl, is an emergency medicine physician, board member of the Florida College of Emergency Physicians, and health writer. You can find him at RajivBahlMD.com.

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