In the 1990s, pharmaceutical companies, insurance companies, and pain doctors endorsed opioids as pain relievers for many common conditions, including chronic pain conditions such as osteoarthritis. They fraudulently stated that opioids were safe to use and did not have high addiction potential. This led to an increased surge in opioid prescriptions which caused a massive increase in overdose rates in the US. From 1999 to 2017, opioid-related overdose deaths increased nearly sixfold.
In 2016, the Centers for Disease Control & Prevention (CDC) developed the Guideline for Prescribing Opioids for Chronic Pain. Born out of America’s opioid epidemic and struggle with pain, the CDC analyzed research on opioid prescribing and pain treatment to ultimately develop the guide.
The guide was meant to apply to patients and providers in particular settings where opioids might be considered or used for treating pain. Recently, the CDC guide was updated and is currently in draft form for public comment.
In contrast to the initial CDC guide, the proposed update is more complete and connects the relationship between pain and opioid addiction. Specifically, the update provides a synopsis of the available evidence and a discussion on opioid addiction and medications that are FDA approved for Opioid Use Disorder (OUD) treatment. In particular, the update provides information on Buprenorphine as it relates to both pain and OUD treatment.
The new guidelines, due to be released in July of 2021, aim to balance the necessary use of opioids for patients with severe pain while limiting the potential for abuse and overdose. The 12 recommendations proposed in the 229-page document change the “one-size fits all approach” to individualized assessments that take multiple factors such as physical examination, pain threshold, medical history, patient response to treatment, and collaboration from numerous healthcare professionals. Physicians are being urged to look at each patient’s situation and assess the risk and benefits of prescribing opioids for chronic, sub-acute, and acute pain.
PROP finds the CDC’s draft guideline to be a valuable contribution. Whereas the 2016 guideline was based on the best available evidence at the time, the present guideline is updated to include what has become a vastly expanded evidence base consisting of many additional studies, often conducted to fill knowledge gaps existing in 2016. Updating the evidence review in the draft has been a formidable task achieved to the highest standards. The new guideline has also taken steps to minimize the risk that opioids will be abruptly discontinued in patients who are physiologically dependent on opioids.
PROP’s goal is to improve the guideline and our response and recommendations seek to add clarity and separation between guidelines intended for opioid-naïve patients, and those that are already taking opioids long-term or at elevated doses. It is clear that the previous version of the guidelines did not delineate the differences in the practices that should be followed, leading to unintended consequences for many patients.
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