Addiction experts are advocating for the CDC’s opioid guidelines to be updated to include viable alternatives for pain management.
As the opioid crisis surges on, it seems odd the Centers for Disease Control and Prevention (CDC) suggests guidelines for practitioners prescribing Schedule II acting opioids for first-time pain intervention. Ultimately, the focus has been on educating clinicians on best practicing practices rather than viable alternatives.
The federal guidelines suggest, “Primary care clinicians report having concerns about opioid pain medication misuse, find managing patients with chronic pain stressful, express concern about patient addiction, and report insufficient training in prescribing opioids. Across specialties, physicians believe that opioid pain medication can be effective in controlling pain, that addiction is a common consequence of prolonged use, and that long-term opioid therapy often is overprescribed for patients with chronic noncancer pain. These attitudes and beliefs, combined with increasing trends in opioid-related overdose, underscore the need for better clinician guidance on opioid prescribing. Clinical practice guidelines focused on prescribing can improve clinician knowledge, change prescribing practices and ultimately benefit patient health.”
The agency assures, “This CDC guideline offers clarity on recommendations based on the most recent scientific evidence, informed by expert opinion and stakeholder and public input…Using guidelines to address problematic prescribing has the potential to optimize care and improve patient safety based on evidence-based practice, as well as reverse the cycle of opioid pain medication misuse that contributes to the opioid overdose epidemic.”
Having opioids as the go-to takes the focus off of Schedule III alternatives, which could also effectively in counteracting symptoms as well as the risks of respiratory depression, dependence, and even death associated with opioid use. The current guidelines include a disclaimer of sorts that opioids should not be used as first line of therapy, indicating, “Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain. Clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient. If opioids are used, they should be combined with nonpharmacologic therapy and nonopioid pharmacologic therapy, as appropriate.” However, there is no information on viable alternatives or their recommended dosages that can be used instead of an opioid drug.
“Before starting opioid therapy for chronic pain, clinicians should establish treatment goals with all patients, including realistic goals for pain and function, and should consider how opioid therapy will be discontinued if benefits do not outweigh risks,” the CDC says, adding, “Clinicians should continue opioid therapy only if there is clinically meaningful improvement in pain and function that outweighs risks to patient safety.” This leaves it up to the prescriber to determine whether opioid therapy has proven to be beneficial for a patient or if the risks outweigh the benefits. Sometimes, it takes a patient becoming physically dependent on a drug before a physician reviews the treatment plan, and by then, it may be too late.
The CDC specifically mentions the guidelines do not focus on “patients who are in active cancer treatment, palliative care, or end-of-life care.” These patients tend to most often receive opioid treatment and many powerful opioids entered the market with the proposed intention to treat cancer and those in hospice care. The rest of the population, however, should be given clearer instructions on the availability of alternative treatments even before opioids are considered.