Manchin Applauds Release of CDC Guidelines for Responsible Opioid Prescribing
Washington, D.C. – U.S. Senator Joe Manchin (D-WV) applauded the release of the Centers for Disease Control and Prevention’s (CDC) guidelines for prescribing opioids for managing chronic pain. The guidelines will help physicians take into account the very real and prevalent danger of addiction and overdose death when prescribing opioids for chronic pain. They will help reduce opioid addiction and diversion and save lives without compromising access to needed treatment. The guidelines, detailed below, encourage doctors to try non-opioid pain management and therapies before prescribing opioids for chronic pain, to only use opioids when the benefits outweigh the substantial risks, and to prescribe the lowest effective dosage when treating patients with opioids.
“These guidelines represent a commonsense approach to preventing opioid addiction and are crucial in our fight to end the drug abuse epidemic,” Senator Manchin said. “I have pushed for the release of these guidelines because I have seen firsthand the devastating effects of prescription drug abuse on individuals, families, and communities in West Virginia. These guidelines will encourage responsible opioid prescribing practices and are therefore a critical part of our fight to end this epidemic.”
In December, Senator Manchin sent a letter to the U.S. Department of Health and Human Services (HHS) Secretary Sylvia Mathews Burwell urging the agency to support the release of the Centers for Disease Control and Prevention’s (CDC) Draft Guidelines for Opioid Prescribing, which were delayed in response to pressure from outside groups, including the Food and Drug Administration (FDA). Please read the full text of the letter here.
CDC recommendations for prescribing opioids for chronic pain outside of active cancer, palliative, and end-of-life care:
- Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain. Clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient. If opioids are used, they should be combined with nonpharmacologic therapy and nonopioid pharmacologic therapy, as appropriate.
- Before starting opioid therapy for chronic pain, clinicians should establish treatment goals with all patients, including realistic goals for pain and function, and should consider how therapy will be discontinued if benefits do not outweigh risks. Clinicians should continue opioid therapy only if there is clinically meaningful improvement in pain and function that outweighs risks to patient safety.
- Before starting and periodically during opioid therapy, clinicians should discuss with patients known risks and realistic benefits of opioid therapy and patient and clinician responsibilities for managing therapy.
- When starting opioid therapy for chronic pain, clinicians should prescribe immediate-release opioids instead of extended-release/long-acting (ER/LA) opioids.
- When opioids are started, clinicians should prescribe the lowest effective dosage. Clinicians should use caution when prescribing opioids at any dosage, should carefully reassess evidence of individual benefits and risks when increasing dosage to ≥50 morphine milligram equivalents (MME)/day, and should avoid increasing dosage to ≥90 MME/day or carefully justify a decision to titrate dosage to ≥90 MME/day.
- Long-term opioid use often begins with treatment of acute pain. When opioids are used for acute pain, clinicians should prescribe the lowest effective dose of immediate-release opioids and should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. Three days or less will often be sufficient; more than seven days will rarely be needed.
- Clinicians should evaluate benefits and harms with patients within 1 to 4 weeks of starting opioid therapy for chronic pain or of dose escalation. Clinicians should evaluate benefits and harms of continued therapy with patients every 3 months or more frequently. If benefits do not outweigh harms of continued opioid therapy, clinicians should optimize other therapies and work with patients to taper opioids to lower dosages or to taper and discontinue opioids.
- Before starting and periodically during continuation of opioid therapy, clinicians should evaluate risk factors for opioid-related harms. Clinicians should incorporate into the management plan strategies to mitigate risk, including considering offering naloxone when factors that increase risk for opioid overdose, such as history of overdose, history of substance use disorder, higher opioid dosages (≥50 MME/day), or concurrent benzodiazepine use, are present.
- Clinicians should review the patient’s history of controlled substance prescriptions using state prescription drug monitoring program (PDMP) data to determine whether the patient is receiving opioid dosages or dangerous combinations that put him or her at high risk for overdose. Clinicians should review PDMP data when starting opioid therapy for chronic pain and periodically during opioid therapy for chronic pain, ranging from every prescription to every 3 months.
- When prescribing opioids for chronic pain, clinicians should use urine drug testing before starting opioid therapy and consider urine drug testing at least annually to assess for prescribed medications as well as other controlled prescription drugs and illicit drugs.
- Clinicians should avoid prescribing opioid pain medication and benzodiazepines concurrently whenever possible.
- Clinicians should offer or arrange evidence-based treatment (usually medication-assisted treatment with buprenorphine or methadone in combination with behavioral therapies) for patients with opioid use disorder.
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