The Centers for Disease Control and Prevention released new guidelines for doctors treating patients with pain on Thursday that reverse a 2016 version used to drastically reduce opioid prescriptions, ultimately leading to devastating results for some. patients with pain.
New guidelines avoid hard numbers on dosage and duration of opioid prescriptions, recommends how and when to prescribe opioids and describes the harms and benefits. But the CDC stressed that the recommendations are voluntary and flexible and should not be used to support a single policy.
The original version was intended for primary care doctors who treat patients with chronic pain, but ended up being used by states, licensing boards, insurers, pharmacies and others to force millions out of Americans to quickly reduce or discontinue prescription opioids.
Pain patient advocates said the update improves on the original version that brought abrupt changes for the 8 million to 13 million Americans who take opioids to manage pain. But they said prescribers, insurers and others need to adopt more nuanced policies to avoid harms such as addiction, suicide and diminished quality of life.
“The CDC is sending a pretty strong message to all payers, states, and healthcare systems that they need to reverse course, that they’ve misapplied the (2016) guideline, and that they need to change because they’re causing harm. “said Kate Nicholson, executive. director and founder of the National Pain Advocacy Center.
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What are the new recommendations?
Guidance covers whether to prescribe opioids for pain, determining dosages, how long initial fills last, and how and when to monitor patients.
CDC guidelines state that physicians should:
- Discuss alternative therapies and prescribe the lowest dose for patients who have never taken opioids before.
- Recommend pain medication for patients with chronic pain only if the benefits and ability to perform daily tasks outweigh the known risks, which may include addiction, overdose and death.
- Discuss the risks and benefits and consider how opioid prescriptions will be discontinued.
- Rely on other therapies and try to taper doses or stop opioids for patients already on higher doses.
Unless there is a life-threatening problem such as signs of overdose, doctors should not abruptly discontinue or quickly reduce doses of opioids, according to guidelines.
“Pain patients should receive compassionate, safe, and effective pain care,” said Christopher Jones, acting director of the CDC’s National Center for Injury Prevention and Control. “We want clinicians and patients to have the information they need to weigh the benefits of different pain treatment approaches, with the goal of helping people reduce their pain and improve their quality of life.”
How is this different from the old recommendations?
According to the old recommendation, patients with chronic pain complained of being cut off from pills they had taken for months or even years. Some people undergoing treatment for cancer, sickle cell disease or recovering from surgery could not get painkillers, even though the policy did not focus on these people.
The updated guidelines contain recommendations for people with short-term pain lasting less than a month, persistent pain lasting one to three months, and chronic pain lasting more than three months.
The original guidelines emphasized that physicians should be careful to avoid daily doses of opioids exceeding 90 milligram equivalents of morphine. The new version advises physicians to be cautious but does not prohibit prescribing daily doses greater than 50 milligram equivalents of morphine. If doctors prescribe so much, the advice recommends that doctors offer education about overdose and naloxone, an anti-overdose drug.
How will the CDC monitor the guidelines?
Although the guidance is voluntary, the CDC will assess and monitor how doctors and patients adjust to the new recommendations.
The CDC plans to educate doctors and others if the agency sees evidence that people are misinterpreting the guidelines or using them as “justification for taking rigid action that applies to all patients,” said Jones on a call with reporters.
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What are the lingering effects of the original advice?
Studies show that more than half of primary care physicians won’t see a patient who takes opioids to manage pain, Nicholson said.
Abruptly decreasing or stopping opioids increases the risk of addiction and suicide for pain patients. Jones said the sharp decrease “creates a very real risk” for patients, including mental health, suicidal thoughts or seeking illicit opioids to avoid withdrawal.
After the 2016 guidelines, more than half of states passed laws that limited initial opioid prescriptions for acute pain to seven days or less. Many states have limited the number of pain medications for people enrolled in Medicaid, and private insurers and pharmacies have also reduced opioid prescriptions. Some states have enacted strict dose limits, prompting doctors to aggressively cut back patients who have been taking opioids for years, and medical boards have disciplined doctors who don’t meet stricter requirements.
After the original guidelines, a non-peer-reviewed survey of more than 3,000 patients found that 84% reported more pain and poorer quality of life, and 42% said they had considered suicide, according to the CDC. .
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Are there disparities between patients with pain?
Black patients have lower overdose rates of prescription painkillers than white, Latino and Native American patients, but a study cited by the CDC showed that black patients were more likely than whites to have limited early refills . Another study showed doctors were much more likely to stop opioids for blacks than for whites if they abused painkillers, the CDC said.
According to the CDC, black patients are less likely to be referred to a pain specialist, and black patients receive low-dose opioids compared to whites.
Ken Alltucker is on Twitter as @kalltucker or can be emailed at email@example.com