CDC Provides Clarification of Opioid Prescribing Guideline

Implementation of the U.S. Centers for Disease Control and Prevention opioid prescribing recommendations should be consistent with the guideline's intent, according to a perspective piece published online April 24 in the New England Journal of Medicine.

Noting that some policies and practices purportedly derived from the 2016 Guideline for Prescribing Opioids for Chronic Pain have been inconsistent with its recommendations, Deborah Dowell, M.D., M.P.H., from the CDC in Atlanta, and colleagues provide clarification of the guideline.

The authors note that the guidelines were developed on the basis of the best available evidence and implementation should not be extended beyond the guideline's statements and intent. Misapplication of the guideline has been reported, including inflexibility in application of the recommended dosage and duration thresholds and policies that encourage hard limits and abrupt tapering of drug dosages, which can result in opioid discontinuation or patient dismissal. In addition, misapplication has been observed for populations outside the scope of the guidelines, including patients with pain associated with cancer, surgical procedures, and acute sickle cell crises. The guideline offers guidance on appropriate tapering, reviewing risks associated with long-term opioid use, collaborating with patients who agree to taper their dose, tapering slowly, and maximizing nonopioid treatment. Appropriate guideline implementation includes maximizing use of physical, psychological, and multimodal pain treatments.

"In situations for which the evidence is limited, it is particularly important not to extend implementation beyond the guideline's statements and intent," the authors write.

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