CDC Issues New Opioid Prescription Guidelines to Primary Care Physicians

On March 15, 2016, the Centers for Disease Control and Prevention (CDC) issued guidelines on prescribing opioid painkillers that were aimed at primary care physicians. These guidelines were a response to the opioid epidemic that has resulted in opioid abuse, overdose, and death. Primary care physicians prescribe nearly half of the opioid painkillers consumed in the United States. These guidelines are not intended for physicians treating cancer patients or for end-of-life care. These guidelines come after several other attempts in recent years to curb the epidemic. In 2014, the Drug Enforcement Agency re-classified some controlled substances from Schedule 3 to the more restrictive Schedule 2. The Obama administration also stepped up general spending on treatment and prevention programs in response.

At the center of the guidelines is the recommendation that non-opioid therapy be the first line of treatment for chronic pain and that opioids only be prescribed when their benefits for pain and function outweigh the risks.

These guidelines have sparked a fierce debate. Some pain specialists and patient advocates have remarked that these guidelines could deny patients pain relief. The line between drug-addicted patients who do not truly need relief and legitimate patients is blurry and difficult to identify.

As the number of deaths from opioids has increased, state and federal agencies have implemented a variety of solutions in attempts to curb these deaths. Some states, like Nebraska, have mandated limits of opioid medications that patients may be prescribed per year. Other states have instituted “pain management contracts,” where patients must agree to random drug testing before receiving an opioid prescription. And many medical associations now offer doctors training in opioids and chronic pain, encouraging them to first try alternative remedies like physical therapy, acupuncture, anti-inflammatories, antidepressants, and counseling. While these other options can work, they don’t always work for some patients who legitimately have an immense amount of pain. These other options can also be much costlier than opioid medications, and not all insurance programs cover all of these remedies.

Critics of the CDC guidelines have argued that the guidelines are not based in strong evidence. However, Dr. Debra Houry, director of the CDC’s National Center for Injury Prevention and Control, counters that evidence for the benefits of opioid medications is also lacking.

While the guidelines are not perfect, they play an important role in the debate around opioid therapy, and finding the line between drug-addicted patients and legitimate ones who need relief.

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