CRA eJournal

CDC Urges Switch to Non-Opioid Therapies

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In November the U.S. Centers for Disease Control and Prevention released revised guidelines for opioid prescribing with new recommendations for providers that emphasize greater communication with patients and states that opioids should not be on the front line for managing pain. The CDC’s previous guidelines released in 2016 recommended what many considered harsh reductions in pain medication prescribing that led to a host of laws and other regulations that left pain undertreated and often unmanaged, according to experts.

“What the guidelines say is that opioids have a place; however, there still needs to be a very thoughtful approach to using opioids, and, whenever possible, the way out of pain is still non-drug and non-opioid,” said Dr. Marcos Iglesias, Hartford, Connecticut-based vice president and chief medical director of Travelers Cos. Inc. “I think it balanced some of the message that some in society took after the 2016 guidelines, which was that opioids are only bad.”

According to a summary published by the CDC, all patients should receive safe and effective pain treatment options.

The CDC acknowledged in its new guidelines, which are voluntary not mandatory, that some of its previous recommendations resulted in “misapplication” of strategies for limiting opioid prescribing and, in some cases, abrupt discontinuation of opioids that jeopardized patients’ health.

The 12 recommendations found in CDC Clinical Practice Guideline for Prescribing Opioids for Pain–United States, 2022 should be administered according to following actions:

1) Determine whether or not to initiate opioids for pain,
2) Select opioids and determining opioid dosages,
3) Decide duration of initial opioid prescription and conducting follow-up, and
4) Assess risk and address potential harms of opioid use.

The Benefits and Risks of Opioid Tapering

The CDC stated that emerging data support clinicians’ carefully weighing the benefits and risks of tapering, or gradually reducing the amount of opioids, along with the benefits and risks of continuing opioids. Although clinicians and patients might not always be able to agree on whether tapering is necessary, the 2022 Clinical Practice Guideline describes an approach to implementing treatment changes in a patient-centered manner while avoiding patient abandonment and supporting the need for clinicians to have shared decision making with their patients.

The 2022 Clinical Practice Guideline does not support rapid dosage tapering, patient abandonment, or abrupt discontinuation of opioids. Scientific evidence, changes in opioid prescribing, and patient input shaped the 2022 Clinical Practice Guideline’s content, format, and increased focus on acute pain, tapering best practices, and safe and effective non-opioid treatment options.

Guidance for Clinicians Working with Patients on Pain Management

CDC provides guidance to help clinicians know how to work with patients to manage pain. This guidance emphasizes:

• Individualized patient care
• Safe and effective pain management options
• Improving communication between clinicians and patients so they can make decisions together about the best care for the patient
• Reducing risks associated with opioid pain therapy, including opioid use disorder, overdose, and death.

Nikki Wilson, Omaha, Nebraska-based senior director of clinical services for Mitchell Pharmacy Solutions told Business Insurance magazine that the new approach is a good one, especially for the workers compensation industry, which has grappled with limiting opioids for “legacy” claimants who have been on the drugs for years.

“The concern has been that there has to be some sort of experience around weaning,” she said. “It’s almost critical to engage a clinician who has experience in it, and not all prescribers do. It’s not their fault, it’s just something that is typically not addressed.”

Experts have said that taking a person off opioids once they are chemically dependent on them can be a dangerous balancing act.

The new guidelines will likely push more doctors to learn and develop weaning strategies, something that hasn’t been addressed in traditional medical training, Ms. Wilson said.

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