CDC Updates Its Opioid Prescribing Guidelines

CDC Updates Its Opioid Prescribing Guidelines

January 26, 2023
By Amanda Fuller

On November 4, 2022, the CDC released new guidelines for the prescription of opioids for pain.[1] The new guidelines have been described as a “corrective” measure after the 2016 CDC Guidelines were often misinterpreted by health systems, physicians, and state governments.[2] The CDC released the 2016 guideline in response to alarming increases in overdose deaths involving opioids. From 1999-2010, opioid prescriptions increased fourfold. This was paralleled by a fourfold increase in deaths from opioid overdose and a similar increase in prescription opioid use disorder.[3] Although the goal of the 2016 Guideline “was to reduce excessive and unnecessary opioid prescribing,” the Guideline had unintended consequences, including patients being forced off their opioids, doctors ceasing to prescribe opioids entirely, facilities closing their pain clinics, and insurance companies refusing to cover long-term opioid prescriptions.[4] The guidelines were also misapplied to patients undergoing cancer treatment or palliative care.[5] This has led some experts to conclude that “[t]he sudden reduction in the number of opioids prescribed nationally probably contributed to more people using heroin and fentanyl, which almost certainly drove up our national overdose rates.”[6]

Although risk of addiction and overdose are serious known issues with long-term opioid use, opioids nevertheless “can be essential medications for the management of pain.”[7] As of 2019, nearly one in five adults experienced chronic pain, and one in fourteen adults “experienced ‘high-impact’ chronic pain” which is defined as “having pain on most days or every day during the past three months that limited life or work activities.”[8] For this reason, the new 2022 Guideline states that its central tenet “is that acute, subacute, and chronic pain needs to be appropriately and effectively treated regardless of whether opioids are part of a treatment regimen.”[9] Further, “[c]linicians should select nonpharmacologic or pharmacologic treatment modalities, or both, that maximize patient safety and optimize outcomes in pain, function, and quality of life.”[10]

[1] Deborah Dowell; Kathleen R. Ragan; Christopher M. Jones; Grant T. Baldwin; and Roger Chou, CDC Clinical Practice Guideline for Prescribing Opioids for Pain – United States, 2022, 71 MMWR Recomm. Report 1 – 95 (Nov. 4, 2022), http://dx.doi.org/10.15585/mmwr.rr7103a1 [hereinafter “2022 Clinical Practice Guideline”].

[2] Alvin Powell, New CDC Guidelines a “Corrective” for Opioid Prescriptions, Specialist Says, Harvard Gazette (Nov. 21, 2022), https://news.harvard.edu/gazette/story/2022/11/new-cdc-guidelines-a-corrective-for-opioid-prescriptions-specialist-says/.

[3] 2022 Clinical Practice Guideline at 3 (noting that the way in which opioids were prescribed changed during this period as well and they were increasingly prescribed at higher doses for longer periods which are considered “prescribing behaviors associated with opioid use disorder and overdose.”) Id.

[4] Powell, supra note 2.

[5] 2022 Clinical Practice Guideline at 3 – 4.

[6] Powell, supra note 2.

[7] 2022 Clinical Practice Guideline at 2.

[8] Id. at 1.

[9] Id. at 59.

[10] Id.

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