CDC Draft Guidelines Could Curb Opioid Prescribing

SEPTEMBER 21, 2015
Allison Gilchrist, Associate Editor
Draft guidelines from the US Centers for Disease Control and Prevention (CDC) could sharply reduce the role opioids play in primary care-based pain management.
 
During a recent webinar, the CDC outlined 12 new draft guidelines for opioid prescribing in primary care settings.
 
The proposed recommendations address the lack of consistency in opioid prescribing practices across primary care providers, as well as insufficient provider training on the powerful painkillers’ risks and benefits.
 
Prescription opioid sales have increased 300% since 1999, but there has not been a general increase in the amount of pain reported, the CDC said.
 
To address this, the CDC focused its draft guidelines on the following major clinical practice areas:
 
·         Determining when to initiate or continue opioids for chronic pain outside of end-of-life care.
·         Opioid selection, dosage, duration, follow-up, and discontinuation.
·         Assessing risk and addressing harms of opioid use.
 
The first recommendation calls for non-opioid pharmacological therapy and non-pharmacological therapy to be first-line treatment options for chronic pain. Instead of selecting opioids by default, providers should only consider prescribing the analgesics if the anticipated benefits for both pain and function are expected to outweigh risks.
 
As Caleb Alexander, MD, MS, recently explained, “Many patients, as with physicians, may overestimate the effectiveness of opioids and underestimate the risks, including their addictive potential.”
 
The draft guidelines also direct primary care providers “to establish treatment goals with all patients, including realistic goals for pain and function.”
 
Explicitly setting these goals will help providers track a patient’s progress, and if treatment benchmarks aren’t being met, then they can decide which part of the care plan should be reevaluated.
 
Steve Leuck, PharmD, recently wrote that when chronic pain is treated, “it appears the [opioid] dose is increased when the goal of treatment is not met,” whereas when treating most other conditions, “it is not common practice to continue increasing the dose of the medication until the target is achieved.”
 
Although the draft guidelines are targeted at opioid prescribing practices, pharmacists also have a responsibility to remain patient-focused when dispensing prescription pain medications.
 
“Pharmacists should not just say, ‘Let’s get the medication prescribed to the patient,’ but [rather], ‘Let’s get the right medication, for the right reason, at the right time, and in the best form to improve overall care,’” Rolee Pathak Das, PharmD, BCPS, clinical associate professor at the Rutgers University Ernesto School of Pharmacy, told Pharmacy Times.
 
Pharmacists dispensed 259 million opioid prescriptions in 2012, which translates to 1 bottle of analgesic pills for every American adult, according to government figures.
 
The draft guidelines were only available through the webinar and will not be made public by the CDC until they are final.
 


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