CDC cautions against misapplication of 2016 Guideline for Prescribing Opioids for Chronic Pain

In a new commentary published in the New England Journal of Medicine on April 24, 2019, authors of the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain cautioned against policies and practices that misinterpret and misapply its recommendations.

The authors stressed that the guideline’s recommendations on opioids should not be used for purposes outside of chronic pain management in adults aged 18 years and older. The guideline’s misapplication to other patient populations, such as those undergoing active cancer treatment, acute sickle cell crises, or postsurgical pain, could risk the patients’ health and safety.

The authors also advised against “hard limits” or “cutting off” opioids. When first starting treatment, “clinicians should prescribe the lowest effective dosage … [and] avoid increasing dosage to ≥90 morphine milligram equivalents (MME)/day,” unless there is a justified reason to do so. However, the guideline strongly recommends against “abrupt tapering or sudden discontinuation of opioids,” especially when already prescribed long-term at higher doses. Doing so can lead to severe withdrawal symptoms such as “pain and psychological distress,” which may drive some patients to seek opioids from other sources.

Although the guideline supports medication-assisted treatment for patients with opioid use disorder, the authors emphasized that the guideline’s dosage recommendations are not appropriate for this purpose and should only be used for patients experiencing chronic pain.

CDC commended health care providers in their efforts to reduce opioid misuse and improve opioid prescribing, and urged clinicians to continue using their clinical judgment when prescribing opioids for chronic pain. The agency stated that it is important to assess each patient’s unique needs and circumstances and determine if the benefits of opioid treatment outweigh the risks. Providers should first consider and maximize nonpharmacologic and nonopioid therapies for chronic pain before prescribing opioids. In addition, collaboration and follow-up are important to ensure patients' health and safety.

The following resources are available for more information on tapering, dosage, and appropriate application of CDC’s guideline:

Pocket Guide: Tapering Opioids for Chronic Pain

CDC Opioid Prescribing Guideline Mobile App

Applying CDC’s Guideline for Prescribing Opioids Series