Doctors should largely avoid prescribing opioids for chronic pain outside of cancer or end-of-life care, and must provide the lowest possible effective dosage whenever they recommend the drugs, according to new federal guidelines aimed at curbing the overprescription of painkillers.
“Opioids should not be the first-line treatment for chronic pain,” CDC Director Tom Frieden told reporters. “They should only be used when their benefits outweigh their substantial risks.”
The Centers for Disease Control and Prevention issued the controversial guidelines Tuesday after delaying their publication due to a major backlash from lawmakers and several patient groups, some of which were backed by big pharmaceutical companies.
The guidelines became a political pincushion, as Democratic senators grew angry that the CDC delayed publication of a tool that could help deal with an epidemic that is killing 44 people each day.
On the other side, some Republicans accused the CDC of not using proper procedures to create the guidelines. And some patient advocacy groups questioned the quality of the evidence used to make the guidelines.
In the wake of that fight, the CDC decided last year to delay publication and hold a comment period that ended in January.
The agency said on Tuesday that it followed a “rigorous, scientific process using the best available scientific evidence, consulting with experts and listening to comments from the public.”
The recommendations are just those, recommendations. They don’t require doctors to make any changes in how they prescribe painkillers, although patient advocates hope that word from the CDC will make doctors take notice.
Still, pharmaceutical companies and patient groups such as the American Cancer Society worry that such guidelines could restrict patients from getting treatment for their chronic pain.
Public health agencies and the White House have said overprescribing of opioids is a key reason for the growing opioid and heroin abuse epidemic. People are prescribed too many opioids after a minor surgery or pain, get addicted, and then oftentimes shift to heroin because it is cheaper and more available.
The guidelines direct providers on how to “talk with their patients about how to manage pain in the safest, most effective manner,” said Debra Houry, director of CDC’s National Center for Injury Prevention and Control.
According to the guidelines, doctors are recommended to not prescribe opioids for chronic pain outside of cancer, palliative or end-of-life care. It recommends lowest effective dosages and close monitoring of people who receive the drugs.
“Providers should always exercise caution when prescribing opioids and monitor all patients closely,” the guidelines said.
