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New CDC guidelines to help doctors prescribe opioids more safely

Prescription rates have been increasing recently

Opioids are natural or synthetic chemicals that are used to reduce pain, and some of the most common opioids include hydrocodone (Vicodin), oxycodone (OxyContin), methadone and fentanyl. Today, they are commonly prescribed for many painful conditions, and the number of opioid prescriptions has been increasing to the point that rates have now quadrupled since 1999. Although opioids are supported by evidence to be effective for alleviating pain and improving function in the short term, it's not clear if they are also beneficial in the long term for pain lasting more than three months (chronic pain.) In addition, using opioids for any amount of time comes with serious risks, including addiction and overdose. In 2013, approximately 1.9 million people abused or were dependent on prescription opioid pain medication, and between 1999-2014, more than 165,000 people died from an overdose related to opioids.

Many doctors find managing chronic pain to be challenging

Many primary care doctors report that they face challenges when it comes to managing patients with chronic pain. Some doctors claim that managing these patients is stressful, and they are concerned with properly prescribing opioids, as well as the fear that patients may misuse these prescriptions or become addicted. In general, most doctors believe that opioid pain medication can be effective for controlling pain, but addiction is a common problem for patients that take them for too long. They also agree that opioids are generally over-prescribed and that more efforts are needed to regulate this. All of this information highlights the need for more guidance to help doctors manage these patients. With this in mind, The Centers for Disease Control and Prevention (CDC) created an updated set of guidelines for doctors prescribing opioids to treat patients with chronic pain.

Older study is updated and supplemented with a newer study

In order to create these guidelines, the CDC updated a 2014 study called a systematic review that investigated the effectiveness and risks of opioids. A systematic review is a powerful, high-quality study that collects and evaluates all available research on a topic - such as opioid prescriptions - to find common themes and hopefully reach a conclusion. Researchers also conducted another review on the benefits, harms, values, preferences and costs associated with opioids. They were interested in questions related to when opioids should be initially prescribed or continued for chronic pain, which opioids are the safest to prescribe, and how to monitor patients for potential harms. The findings from both of these reviews were combined, and a set of guidelines for prescribing opioids was established.

Recommendations encourage prescribing other drugs first and starting with low dosages

Based on the information reviewed, the researchers put forth a set of 12 recommendations for doctors prescribing opioids. The most important of these include the following:

  • Use non-opioid drugs and other treatments first before opioids; doctors should only consider prescribing opioids if the benefits outweigh the risks, and if prescribed, should be combined with other non-opioid and other treatments like physical therapy
  • Before starting opioids, doctors should establish treatment goals with their patients, discuss the risks and benefits, and consider how the use of opioids will stop if the benefits of using the drugs don't outweigh the risks
  • When opioids are used, doctors should prescribe the lowest effective dosage and only immediate-release opioids instead of extended-release or long-acting opioids
  • Doctors should evaluate the benefits and harms of continued opioid use with their patients every three months or more frequently and review prescription drug monitoring program data, when available, for high-risk combinations or dosages
  • For patients with opioid use disorder, doctors should offer or arrange assistance, such as medication-assisted treatment

As a patient, it's important to be aware of these guidelines so that you know your condition is being properly managed. When making any treatment decision, your doctor should always discuss the available treatment options and carefully explain the risks and benefits associated with each one. This is necessary to make informed decisions and avoid any unnecessary treatments like opioid prescriptions that may be dangerous. Patients should also be aware that many chronic painful conditions can be effectively treated with physical therapy, which is capable of leading to significant improvements without the need for pain medications.

-As reported in the March '16 issue of Recommendations and Reports
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