Guideline Information for Providers
Safe Prescribing Saves Lives
Chronic pain is common, multidimensional, and individualized, and treatment can be challenging for healthcare providers as well as patients. In response to the critical need for consistent and current opioid prescribing guidelines, the CDC released the new Guideline for Prescribing Opioids for Chronic Pain.
Since 1999, opioid prescriptions have quadrupled, and over 165,000 people have died from prescription opioids.1 These new recommendations focus on clinical practice and provide evidence and guidance to improve how these drugs are prescribed—and ultimately improve patient care.
What is the purpose of the new guideline?
The guideline helps providers make informed decisions about pain treatment for patients 18 and older in primary care settings. The recommendations focus on the use of opioids in treating chronic pain—pain lasting longer than three months or past the time of normal tissue healing. The guideline is not intended for patients who are in active cancer treatment, palliative care, or end-of-life care.
Opioids pose a risk to all patients. The guideline encourages providers to implement best practices for responsible prescribing.
Use nonopioid therapies
Use nonpharmacologic therapies (such as exercise and cognitive behavioral therapy) and nonopioid pharmacologic therapies (such as anti-inflammatories) for chronic pain. Don’t use opioids routinely for chronic pain. When opioids are used, combine them with nonpharmacologic or nonopioid pharmacologic therapy, as appropriate, to provide greater benefits.
Start low and go slow
When opioids are used, prescribe the lowest possible effective dosage and start with immediate-release opioids instead of extended-release/long-acting opioids. Only provide the quantity needed for the expected duration of pain.
Regularly monitor patients to make sure opioids are improving pain and function without causing harm. If benefits do not outweigh harms, optimize other therapies and work with patients to taper or discontinue opioids, if needed.
What’s included in the guideline?
The guideline addresses patient-centered clinical practices including conducting thorough assessments, considering all possible treatments, closely monitoring risks, and safely discontinuing opioids. The three main focus areas in the guideline include:
- Determining when to initiate or continue opioids for chronic pain
- Selection of non-pharmacologic therapy, non-opioid pharmacologic therapy, opioid therapy
- Establishment of treatment goals
- Discussion of risks and benefits of therapy with patients
- Opioid selection, dosage, duration, follow-up and discontinuation
- Selection of immediate-release or extended-release and long-acting opioids
- Dosage considerations
- Duration of treatment
- Considerations for follow-up and discontinuation of opioid therapy
- Assessing risk and addressing harms of opioid use
- Evaluation of risk factors for opioid-related harms and ways to mitigate/reduce patient risk
- Review of prescription drug monitoring program (PDMP) data
- Use of urine drug testing
- Considerations for co-prescribing benzodiazepines
- Arrangement of treatment for opioid use disorder
What’s new in the CDC Guideline?
The dosage recommendations for exercising caution are lower than older opioid prescribing guidelines. Higher doses of opioids are associated with higher risk of overdose and death—even relatively low doses (20-50 morphine milligram equivalents (MME) per day) increase risk.
Assessing Risks and Harms
Previous guidelines focused safety precautions on “high risk patients,” however, opioids pose risk to all patients, and currently available tools cannot rule out risk for abuse or other serious harm. The CDC guideline provides recommendations on providing safer care for all patients. The guideline also encourages use of recent technological advances, such as state prescription drug monitoring programs.
Monitoring and Discontinuing
The guideline provides more specific recommendations compared to previous guidelines on monitoring and discontinuing opioids when risks and harms outweigh benefits.
What else is CDC doing?
The new prescribing guideline is just one of the strategies to reduce the number of people who suffer from opioid use disorder or overdose related to these drugs. Other efforts include:
Poison Help & Treatment Locator
If you suspect your patient has a substance abuse issue, refer them to SAMHSA’s National Helpline at 1-800-662-HELP (4357) or SAMHSA’s Behavioral Health Treatment Services Locator.
- CDC. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2016. Available at http://wonder.cdc.gov.