Responding to a backlash from pain patients, the Centers for Disease Control and Prevention released updated guidelines Thursday that offer clinicians more flexibility in prescribing opioids for short- and long-term pain. The new recommendations eliminate numerical dose limits and caps on the length of treatment for chronic pain patients that had been suggested in the 2016 version of the agency’s advice, which was aimed at curbing the liberal use of the medication and controlling a rampaging opioid epidemic, reports the Washington Post. Those guidelines cautioned doctors that commencing opioid therapy was a momentous decision for patients. Parts of that nonbinding document were widely misinterpreted, resulting in unintended harm to patients who benefited from the use of opioids without the risk of addiction. Patients reported they were rapidly tapered off medication by doctors or saw their medication abruptly discontinued. Some insurers and pharmacies set rigid limits on the duration of prescriptions or dropped patients altogether.
The new 100 pages of guidance for doctors, nurse practitioners and others authorized to prescribe opioids emphasize returning the focus to the caregiver and patient deciding on the best course of treatment. “This guideline is really intended to be a mechanism to help patients and providers work together,” said Christopher Jones of CDC’s National Center for Injury Prevention and Control. “We have leaned in on more principles, rather than thresholds.” Though a record 107,000 Americans died of opioid overdoses in 2021, much about the epidemic has changed since 2016. The number of prescriptions for opioids, which peaked at more than 255 million in 2012, was at nearly 215 million when the CDC released the first set of guidelines. By 2020, that number had declined to 142 million. The ongoing overdose epidemic is now caused mainly by illegal fentanyl, which is laced into a variety of street drugs and consumed, sometimes unknowingly, by users. Yet, chronic pain — which lasts more than three months — remains one of the most common conditions suffered by U.S. patients. In 2019, one in five adults reported chronic pain, and one in 14 said it limited life or work activities, according to the CDC. Chronic pain is blamed for $560 billion to $635 billion in direct medical costs, lost productivity and disability each year, and contributes to nine percent of suicides.