Parts of that non-binding document have been widely misunderstood and have resulted in unintended harm to patients who were benefiting from opioid use with little risk of addiction. reported that they either reduced their doses or stopped their medications abruptly, the CDC confirmed in a new document. Some insurance companies and pharmacies have strict limits on the duration of prescriptions or drop patients outright.
The new 100-page guidance is merely recommendations for physicians, nurse practitioners, and others authorized to prescribe opioids, but returns the focus to caregivers and patients to determine the best course of treatment. is emphasized.
“These guidelines are intended as a mechanism for patients and providers to work together,” Christopher Jones, acting director of the CDC’s National Center for Injury Prevention and Control, said in an interview Thursday. “We’ve relied on more principles than thresholds.”
A record 107,000 Americans will die from opioid overdoses in 2021, but much has changed about the epidemic since 2016. In 2012, he peaked at over 255 million opioid prescriptions, and was still close to 215 million when the CDC announced its first prescriptions. A set of guidelines.
By 2020, that number had dropped to 142 million. This reflects efforts to reduce opioid use in favor of other approaches to pain and the recognition that many addictions begin with prescription drugs.
The ongoing overdose epidemic is now largely driven by illicit fentanyl. Fentanyl is found in many street drugs and is sometimes ingested unknowingly by users.
However, chronic pain (defined as pain that lasts longer than three months) is one of the most common conditions afflicting patients in the United States. According to the CDC, in 2019, 1 in 5 of her adults reported chronic pain, and 1 in 14 of her said it limited her life and work activities. Chronic pain is responsible for $560 billion to $635 billion in direct medical costs, lost productivity, and disability each year, and contributes to his 9% of suicides. agency said.
The new recommendations were proposed in February and sent for comment from the public and experts before being adopted by the CDC. They took into account studies on opioids conducted since 2016. As with previous versions, they are not intended to treat pain caused by sickle cell disease or cancer, or for palliative or end-of-life care that requires special attention from caregivers.
Sidarth Wakul, associate director of the Addiction Division at the University of Texas Southwestern Medical Center in Dallas, endorsed the new guidelines.
“We needed more flexibility rather than weaning patients who really needed them off their meds,” he said in an email. “Opioid addiction is, of course, a serious problem and requires caution. But this new approach will be of great help to patients who otherwise would not have been treated.”
At least one group wanted the guideline to hold on to the numerical upper bound in one of the bolded recommendations for prescribers. In a March 25 letter, a responsible opioid prescribing physician, one of the fiercest critics of liberal opioid use, said prescribers were likely to face a “reduced harvest” as the daily line. , advised to emphasize the upper limit of 50 morphine milligram equivalents. The numbers are listed deep within the guidance.
As with previous guidelines, the new version recommends that caregivers try non-opioid approaches for pain relief before starting medication. It also notes disparities in care for people of color, some of whom are less likely than whites to be referred to a pain specialist or undergo a postpartum pain assessment. Blacks also receive lower doses of painkillers than whites.
The new recommendations also include advice on how physicians and patients can discuss dose reduction. A warning that clinicians should “weigh the benefits and risks and exercise caution when changing opioid dosages.” and a notice that patients should be “periodically reassessed the benefits and risks of continued opioid therapy.”
“It’s never intended to be a panacea,” Jones said. “These are just signposts.”
