CDC Proposes Updates to Controversial 2016 Opioid Prescribing Guidelines

On February 10, 2022, the Centers for Disease Control and Prevention (CDC) issued new proposed guidelines for prescribing of opioids for acute, sub-acute and chronic pain. The clinical practice guideline updates and expands the CDC Guideline for Prescribing Opioids for Chronic Pain— United States, 2016, and provides evidence-based recommendations for clinicians who provide pain care, including those prescribing opioids, for outpatients age 18 years and older with acute pain (duration less than 1 month), subacute pain (duration of 1–3 months), or chronic pain (duration of 3 months or more).

The guideline explicitly EXCLUDES sickle cell disease-related pain management, cancer pain treatment, palliative care, and end-of-life care.

The clinical practice guideline includes recommendations for primary care clinicians (including physicians, nurse practitioners, and physician assistants) as well as for outpatient clinicians in other specialties (including those managing dental and postsurgical pain in outpatient settings and emergency clinicians providing pain management for patients being discharged from emergency departments).

This voluntary clinical practice guideline provides recommendations and does not require mandatory compliance; and the clinical practice guideline is intended to be flexible so as to support, not supplant, clinical judgment and individualized, patient-centered decision-making.

As part of the guideline issuance, CDC is asking interested persons or organizations to submit written views, recommendations, and data. In order to be considered, written comments must be received on or before April 11, 2022.  Instructions for submitting comments and various materials are available HERE; the revised guideline and other supporting materials are located in the “Enhanced Content” box in the lower right hand corner of the page.

A major area of concern associated with the 2016 guideline was the emergence of misapplication of the guideline by various state and local governments. In 2018 the National Association for Home Care & Hospice (NAHC) was invited to testify before the House Energy & Commerce Committee regarding hospice disposal of controlled substances.

As part of his testimony, NAHC’s representative Dr. John Mulder of the Trillium Institute and Faith Hospice in Michigan, commented on the misapplication of the 2016 CDC guideline by states that have resulted in delayed treatment for pain experienced by individuals receiving palliative or hospice care. In 2019, CDC issued a Media Statement  on the 2016 guideline cautioning against:

  • Misapplication of recommendations to populations outside of the Guideline’s scope;
  • Misapplication of the Guideline’s dosage recommendation that results in hard limits or “cutting off” opioids;
  • Abrupt tapering or sudden discontinuation of opioids; and
  • Misapplication of the Guideline’s dosage recommendation to patients receiving or starting medication-assisted treatment for opioid use disorder.

These concerns, in part, led to issuance of the revised guideline that is currently under review.