The U.S. Centers for Disease Control and Prevention (CDC) proposed new guidelines on opioid prescribing that are intended to ‘support, not supplant, clinical judgment and individualized, patient-centered decisionmaking.’ The CDC stressed that the guidelines are not to be ‘applied as inflexible standards.’ Some policymakers treated the current guidelines, which were issued in 2016, as hard limits for prescribing opioids. The draft guidelines issued last week still say that ‘opioids should not be considered first-line or routine therapy for subacute or chronic pain’ and also identify treatments for acute pain that are better than opioids. The guidelines recommend physicians always prioritize non-opioid medications and interventions. However, the draft guidelines remove language from the 2016 guidelines that said doctors should ‘avoid increasing dosage’ to 90 morphine milligram equivalents or more a day unless they can ‘carefully justify’ the dosage. The clinical practice guideline is intended to achieve the following: (1) Improved communication between clinicians and patients about the risks and benefits of pain treatment, including opioid therapy for pain. (2) Improved safety and effectiveness for pain treatment, resulting in improved function and quality of life for patients experiencing pain. (3) A reduction in the risks associated with long-term opioid therapy, including opioid use disorder, overdose, and death. The American Medical Association supports the changes in the draft guidance. The ‘list of misapplications of the 2016 guideline is long, and its impact has been tremendous harm,’ said Dr. Bobby Mukkamala, M.D., chair of the AMA board of trustees and Chair of the AMA substance use and pain care task force in a statement. ‘In addition, the guideline did nothing to stem the drug overdose epidemic sweeping the country. In fact, the epidemic has become more lethal despite the CDC restrictive guideline due to illicitly manufactured fentanyl, fentanyl analogs, heroin, methamphetamine and cocaine.’ The relaxed-guidance initiative comes as the opioid crisis continues to take its toll in both lives and taxpayer dollars. Research has shown strong connections between the prescribing of opioids for chronic pain and opioid misuse and addiction. As many as 29 percent of patients who are prescribed opioids for chronic pain misuse them and up to 12 percent will develop an opioid use disorder, according to the National Institute on Drug Abuse. The misuse of prescription opioids can also lead to the use of illicit drugs such as heroin, with an estimated 80 percent of people who use heroin first misusing prescription opioids. Prescription opioid misuse is estimated to create a $78.5 billion 'economic burden' on the U.S. economy every year. The diversion of prescription opioids into the illicit drug market remains rampant. Physicians operating ‘pill mills” overprescribe opioids to individuals when there is no legitimate medical necessity for the prescription and when the physician knows the prescription opioids are likely to be diverted.
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