The updated opioid prescribing guidelines from the Centers for Disease Control and Prevention (CDC) are the first since 2016. The revisions include caution against abruptly stopping or rapidly reducing the prescribed opioid dosage.
“And that is based on lessons learned over the last several years as well as new science about how we approach tapering and the real harms that can result when patients are abruptly discontinued or rapidly tapered,” said Dr. Christopher Jones, acting director of the National Center for Injury Prevention and Control and co-author of the 2022 clinical practice guideline, in a call with reporters Nov. 9.
“And we have seen that play out certainly in the research and also from personal stories from patients whose clinicians stop prescribing to them, or abandon them from care, or rapidly forced them to get too much lower doses of opioids,” jones said. “And there are very real harms. We tried to highlight that in the guideline. So things like mental health crises, suicidal ideation or behavior, psychological distress, and potentially even for some people seeking out opioids through other markets, like illicit markets, in order to stave off withdrawal, or to supplement if they are at too low of a dose.”
The latest guidelines make distinctions between opioid prescribing for acute pain (lasting less than a month), subacute pain (lasting one to three months) and chronic pain (lasting longer than three months). For instance, recommendations include exercise therapy for back pain, fibromyalgia and knee osteoarthritis.
“There’s clear data that the non-steroidal medications or the NSAIDs are more effective than opioids for pain related to ankle sprain,” said Dr. William Becker, internist and associate professor at the Yale School of Medicine. “So partly the message that the new guidance explains, it’s not just about the risk of opioids in acute pain. For many conditions, many common conditions, other medications are more effective.”
Becker said critics of the initial guideline thought that restricting long-term opioid therapy to certain dose thresholds may have created an environment where providers were encouraged to rapidly taper patients off opioids. The guidelines reemphasize that tapering may be used but should only be done in collaboration with the patient.
The recommendations also call for naloxone for patients receiving longer-term opioids for chronic pain. Naloxone is used to reverse an opioid overdose.
