The CDC’s 2022 Draft Guidance on Pain Management and Opioid Use
On February 10th, the Centers for Disease Control and Prevention (CDC) issued an updated draft of its Clinical Practice Guideline for Prescribing Opioids. This draft provides revisions to the 2016 guideline, supported by new evidence and research in the field of pain management1. As the guideline is currently in draft, the CDC has opened the docket for public comment on its new recommendations.
Similar to the 2016 guidance, the guideline advises providers to limit the use of opioids when possible. If indicated, clinicians should consider alternative, non-opioid therapies for chronic and acute pain conditions. Such alternatives include other pharmacologic therapy (e.g., gabapentin or ibuprofen) and nonpharmacologic options (e.g., physical therapy). On the contrary, the CDC removed some of its previous recommendations that initially limited opioid use. The new guideline, for example, does not recommend limits on opioid dose and prescription durations as it did previously. It also advises against sudden discontinuation of opioids in certain patients with chronic pain.
Shortcomings of the 2016 guideline
Many of the changes seen in the updated guideline address the shortcomings from the CDC’s 2016 recommendations. One of the biggest changes includes the removal of opioid ceiling doses from the guideline. When the CDC defined these dose thresholds in 2016, certain states began to implement restrictions on opioid prescriptions to abide by these recommendations. For example, some states induced limits on the number of opioid doses or prescription refills a patient could receive. Additionally, many providers started to change their practice to avoid prescribing doses above the CDC-defined maximum. In fact, after the release of the 2016 guidelines, prescription of high-dose opioids declined at an increased rate. Additionally, the average day’s supply of opioid prescriptions decreased2.
These trends suggest how both law and clinical practice changed in response to CDC guidance in 2016. Decreased opioid utilization can be positive as it can also reduce the likelihood of opioid abuse and dependence. However, restricted prescribing can also lessen the quality of pain management for patients with uncontrolled pain. Likewise, the 2016 guideline created barriers to opioid access for many patients who required higher doses of opioids.
Impact of the 2022 guideline
The new draft guideline loosens some of the harsher recommendations from 2016, removing certain dose thresholds. Previously, patients that needed doses higher than the daily 90 morphine milligram equivalents were restricted, resulting in increased pain and decreased quality of life. By removing ceiling doses and allowing for more flexibility, the CDC encourages providers to leverage their clinical judgement when it comes to pain management. This process should involve careful evaluation of an opioid’s benefit-risk profile as well as patient-specific factors, allowing for comprehensive yet individualized treatment plans.
Outside of clinical practice, the 2022 draft guideline may also make an impact at an institutional level. As previous recommendations induced restrictions within prescribing laws and insurance reimbursement, the 2022 guideline may help to ease these restrictions. This would make opioids and pain relief more accessible to those that truly need it, creating balance and promoting compassionate patient care.
- Process for updating the opioid prescribing guideline | CDC’s response to the opioid overdose epidemic | CDC [Internet]. 2022 [cited 2022 Feb 17]. Available from: https://www.cdc.gov/opioids/guideline-update/index.html
- Goldstick JE, Guy GP, Losby JL, Baldwin G, Myers M, Bohnert ASB. Changes in initial opioid prescribing practices after the 2016 release of the CDC guideline for prescribing opioids for chronic pain. JAMA Netw Open. 2021 Jul 13;4(7):e2116860.