Opioid Prescribing: CDC Guidelines and More

Published:

From prohibitive practices that failed to treat pain in the early 90s to over-prescribing that caused the opioid overdose epidemic still ongoing today, prescription opioids have had a complicated history with healthcare professionals in the US.

The Centers for Disease Control and Prevention (CDC) issued clinical practice guidelines in 2016 that aimed to course-correct the use of opioid therapy. Due to multiple complaints that affected patients’ access to life-saving measures, it was revised and rereleased in 2022.

Here’s everything you need to know about opioid prescribing trends and how the CDC seeks to correct opioid prescription issues.

A Background on Opioid Prescribing Trends

In the early 90s, many doctors avoided initiating opioid therapy for pain management due to their addictive nature, in what was colloquially known as “opio-phobia.” Back then, the number of opioid-related overdoses and deaths remained at bay, although many patients struggled to get a prescription for acute pain or even after having major surgery.

By the mid-to-late 90s, the US healthcare system saw a significant shift in how prescribing opioids was approached. Due to lobbying from non-profit groups, as well as from some pharmaceutical companies, the attitude toward opioid prescribing for chronic pain and smaller injuries relaxed.

This brings us to the new millennium, as the opioid crisis was looming in the form of a disproportionate number of opioid prescriptions. The risk of prescription opioid overdose was at an all-time high in 2007, when 78% of all opioid overdose deaths were attributed to them. However, the number of prescriptions wouldn’t peak until 2012, when there were 81.3 doses of opioids prescribed per 100 persons in the US.

This became a public health crisis as prescription opioids became a gateway drug for other illicit opioids. Patients who developed a dependence after taking opioids for chronic pain soon found it cheaper to move on to more potent drugs, such as heroin and fentanyl.

While the percentage of prescription opioid overdose deaths plummeted to 24% in 2020, fentanyl and heroin overdose deaths continue to rise.

In 2016, the CDC’s guidelines for prescribing opioids for pain management were released. It incentivized states to implement changes that limited overprescribing of opioids, which included:

  • Limiting the length and daily dosage of opioid prescriptions for acute pain.
  • Limiting the maximum dose of prescribed opioids for chronic pain under 90 morphine milligram equivalents (MME) per day.
  • A requirement for prescribing the anti-overdose drug, Naloxone, besides the opioid prescription.
  • State policies that created and enforced Prescription Drug Monitoring Programs (PDMPs).

These measures helped contain the problem, with the number of prescriptions dropping to 59 per 100 persons in 2017. But on the flip side, opioid treatment wasn’t prescribed for patients who needed it due to some of these restrictions.

Which brings us to the CDC’s clinical practice guidelines for prescribing opioids in the present day.

The 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain

The main concern of the current guidelines proposed by the CDC for opioid treatment prescription is harm reduction. In fact, the guideline aims to decrease the number of opioid use disorder cases while providing pain management to people who stand to benefit the most from opioid therapy.

The CDC guideline includes the following recommendations:

Key Recommendations

  • Before starting opioid therapy, a clear list of realistic goals should be established when it comes to pain management and function restoration. Resorting to opioid therapy should only happen if the benefits outweigh the potential risks.
  • The risk factors that lead to opioid use disorder, dependence, and overdose should be laid out, and a decision regarding initiating opioid therapy should be made based on the evidence.
  • Using Prescription Drug Monitoring Programs (PDMPs), the patient’s prescription drug use history should be carefully reviewed before prescribing opioids. It should also be reviewed periodically during the course of the opioid treatment.
  • Continued assessment of the patient’s use of prescribed controlled substances or illicit drugs should be carried out via regular urine drug tests.
  • An opioid and Benzodiazepine co-prescription should be avoided whenever possible due to the higher risk of overdose.
  • Overdose prevention tactics, such as prescribing naloxone for high-risk patients, should be carried out.
  • For patients with opioid use disorder (OUD), medication-assisted treatment should be carried out to mitigate acute withdrawal symptoms using methadone and buprenorphine prescriptions, as well as behavioral therapies that reduce the risk of relapse.

For Acute Pain Management

  • The lowest effective dose of immediate-release opioids should be prescribed to manage severe pain after an injury or major surgery.
  • If the treatment for acute pain was longer than 3 days but shorter than 7 days, dose tapering for 2 days at 50% of the dose is recommended.
  • If the treatment was longer than 7 days but shorter than a month, a slower taper is recommended to mitigate potential withdrawal symptoms.

For Chronic Pain Management

  • Nonpharmacologic interventions and nonopioid pain medications are preferred modes of treatment for chronic pain patients. If opioid therapy is required, it should be combined with physical and nonopioid pharmacologic therapies for best results.
  • If prescribing opioids for chronic pain, extended-release/long-active opioids should be avoided. Instead, the lowest effective dose of immediate-release opioids should be prescribed.
  • Within 4 weeks of initiating or increasing dosages of opioid therapy for chronic pain patients, the benefits and risks should be examined against the treatment goals. This should be repeated every 3 months of using opioids for chronic pain.
  • If the risk factors are numerous and outweigh the benefits, a plan to taper the dose and eventually replace opioid prescriptions with nonopioid or nonpharmacologic therapy options should be put in place.

Wrapping Up

The current Centers for Disease Control and Prevention (CDC) recommendations for opioid prescribing aim to treat pain while reducing opioid-related harms like dependence, overdose, and even death.

Since prescription opioids have been proven to be gateway drugs for more serious drug abuse, like heroin and fentanyl, reducing the number of prescriptions is essential to stop the current opioid overdose crisis.

If you or your loved one are facing opioid use disorder or addiction, there’s still a chance to prevent serious risks. Book an appointment today with one of our licensed clinicians to get started on your treatment journey.

Share

Leave a Comment

Join our newsletter

Get Connected. Get Help. Join Us

The Curednation newsletter. We’ll send you unbiased and professional insights from our email list.

Plug in your Email

arrow-blue

All Resources, to help your Recovery

If you’re ready to take the first step on your road to recovery, we’re here for you. Please book an appointment with us today, and let’s get you back to where you want to be.

View all Resources

Is 12 Hours Long Enough to Wait to Take Suboxone?

Typically, you can wait for at least 12 hours after using short-acting opioids before taking Suboxone. That said, the ...

Does Brixadi Have Naloxone in It?

People receiving care for severe opioid use disorder (OUD) are at increased risk of relapse. This makes it critical ...

How Much Is Suboxone With Insurance? (And Without)

Suboxone treatment has become indispensable in managing the ongoing opioid addiction crisis. That said, the cost of medication-assisted treatment ...

How Effective is Vivitrol for Opioid Use Disorder?

If you or someone you love is struggling with opioid use disorder, there is a high chance that Vivitrol ...

How to Get Vivitrol Out of Your System

Vivitrol is an FDA-approved medication used in the treatment of alcohol dependence, as well as to help support sobriety ...

Vivitrol Discount: What’s the Best Way to Save?

If you’re exploring treatment plans for alcohol and opioid dependence, you might come across Vivitrol. Vivitrol is a name-brand ...

Certified, Proven and Private

Curednation: A Place to Recover

If you’re ready to take the first step on your road to recovery, we’re here for you. Please book an appointment with us today, and let’s get you back to where you want to be.

I’ve had a great experience with curednation. I was not sure about it first but I went ahead and started the treatment from them anyways and so far it’s been a dream. The doctors are very nice and helpful.

Ryan

Dr. Carter is awesome I'm so excited to start my new journey and his team also very awesome and they make every visit welcoming.

Silvia

Curednation is truly cares about the well-being of their Patients. I am really happy with the treatment I’ve received so far. A big thank you to the doctors.

Philip

I came across this service because it is more convenient to get virtual help. I had foot surgery and telemedicine is way better than finding a ride and not feel like an inconvenience to other people.

Haley

It was a great experience everybody was kind and very knowledgeable I look forward to our next meeting thank you

Samuel

I have been doing the sessions for the last few weeks and it has been a life changer experience. I will say you have to do the work to get results. The more you do the better you will feel. They will educate you on ABC Medication, breathing technique and nutrition.

Charles