CDC Releases New Prescription Opioid Guidelines for Treating Pain

The Centers for Disease Control and Prevention (CDC) has released new guidelines for prescribing opioid painkillers, a class of highly addictive drugs used to treat severe pain.

The guidelines remove a previous recommended ceiling for opioid dosage—guidance that was met with backlash at the time. Now, the guidelines encourage doctors to use their best judgement when prescribing opioids, and to use “nonopioid therapies” as a first intervention.

“Patients with pain should receive compassionate, safe, and effective pain care,” Christopher M. Jones, PharmD, DrPH, MPH, acting director of CDC's National Center for Injury Prevention and Control, said in a press release. “We want clinicians and patients to have the information they need to weigh the benefits of different approaches to pain care, with the goal of helping people reduce their pain and improve their quality of life.”

The CDC first proposed the new guidelines in February, and opened the draft version up to public comment. For the revised version—revealed Thursday—the CDC took into account feedback from an independent federal advisory committee, four peer reviewers, and members of the public, which included patients with pain, along with their caregivers and clinicians.

“The science on pain care has advanced over the past six years,” Debbie Dowell, MD, MPH, chief clinical research officer for CDC’s Division of Overdose Prevention, said in a press release. “During this time, CDC has also learned more from people living with pain, their caregivers, and their clinicians. We’ve been able to improve and expand our recommendations by incorporating new data with a better understanding of people’s lived experiences and the challenges they face when managing pain and pain care.”

Here’s what to know about the newly issued guidelines, and how they will affect how pain is treated going forward.

New Guidelines for Prescribing Opioids for Pain

The newly-released guidelines are the CDC’s first extensive updates to the CDC’s prescribing guidelines for opioids since 2016, and includes guidance on acute, subacute, and chronic pain.

In the previous guidelines, the CDC heavily discouraged doctors from prescribing opioids, and recommended a ceiling for dosing. The new guidelines have removed that recommended ceiling, but still asks that doctors use other nonopioid alternatives as much as possible—but they stress that doctors can prescribe opioids in certain situations, when they see fit.

Those new nonopioid therapies that doctors are encouraged to try for chronic and acute pain management in patients include:

• Over-the-counter medications like ibuprofen and acetaminophen
• Prescription medications like gabapentin
• Physical therapy
• Massage
• Acupuncture

“Gabapentin has a great role in neuropathic pain,” Jamie Alan, PharmD, PhD, associate professor of pharmacology and toxicology at Michigan State University, tells Health. “Physical therapy also has a huge role in pain management. There are many other choices instead of opioids that are very useful for pain.”

However, as the new guidelines suggest, there’s no one-size-fits-all way to treat pain, and it’s important to take different approaches.

“When treating pain with physical therapy, gabapentin, acetaminophen, NSAIDs, and muscle relaxers, we are treating different receptors and aspects of pain,” Krishna Shah, MD, an interventional pain medicine specialist and assistant professor of anesthesiology at Baylor College of Medicine, tells Health. “If we can attack pain from multiple different angles, we would have the best outcome in managing it. When doctors determine that opioids are needed, the CDC recommends starting patients at the lowest dose possible.”

The proposed new guidelines are welcomed by those who felt the previous ones were too harsh for those who suffer from chronic pain.

“The initial guidelines, although great, were considered too restrictive,” said Dr. Shah, noting that they included things like limiting the use of opioids for acute pain to three days or avoiding increasing opioid dosage to the equivalent of 90 milligrams of morphine daily.

Now, under the new guidelines, “if a surgery or an episode of acute pain requires a longer short-term course of opioids, that would be considered acceptable,” he said.

It’s also important to note that the guidelines also tend to influence insurance coverage and even state law, Jeanmarie Perrone, MD, director of the Division of Medical Toxicology and Addiction Medicine Initiatives at Penn Medicine, tells Health.

“The previous round of guidance was subject to possible misinterpretation, including insurance companies limiting opioids for people with chronic pain,” said Dr. Perrone. “The goal with the new guidance is judicious opioid prescribing with an emphasis on alternative medications for pain.”

The idea behind it, according to Dr. Perrone, is that if patients find an alternative to opioids that works for them, there may be a decrease in opioid addictions.

New Recommendations Do Not Apply to All Conditions

The new guidance stresses that opioids are still needed in certain circumstances, including end of life pain, or pain caused by sickle cell disease or cancer.

“Opioids still have a role in managing pain,” Whitney Luke, MD, a pain medicine specialist at The Ohio State University Wexner Medical Center, tells Health. “They are often used for patients with active cancer and cancer-related pain. They may also be used sparingly for patients who have exhausted other pain management options.”

In addition to starting patients off on the lowest dose possible, the new guidelines encourage doctors to prescribe immediate-release pills, as opposed to long-acting pills, when possible. As the name suggests, immediate-release pills are effective more immediately after being taken, but their effects wear off quicker than those of long-acting pills.

Guidelines Seek to Reduce Opioid Dependency

If you’re already on a prescription painkiller, it’s wise to talk to your healthcare provider about the risks and benefits of your medication, and asking about alternatives that can help. “A referral to an interventional pain physician could also be offered to see if there are any interventions such as injection therapy that may help with their condition,” said Dr. Luke.

Doctors are supposed to be keeping an eye on you if you are on a prescription for an opioid medication, according to Dr. Luke.

“If someone is on opioid medication, their doctor should be meeting with them regularly, at least every two to three months,” she said. “They should be assessing pain relief with the medication as well as if the medication is improving their functional status. They should also be assessing the patient’s risk of overdose and if they are taking the medication as prescribed.”

Any doctor that prescribes an opioid should first check to make sure it won’t interact with another medication their patient is on, explain how to take the medicine safely, confirm that they aren’t abusing it during follow-up appointments, and set realistic expectations about stopping the medication when possible, said Dr. Shah.

The reason for all of these layers of protection is the concern that opioid use will lead to dependence, tolerance issues, and addiction.

In 2019 alone, an estimated 10.1 million people aged 12 or older misused opioids, according to data from the US Department of Health and Human Services (HHS)—and 9.7 million of those people misused prescription pain relievers.

“There is concern that prescription opioid use has spurred more opioid use,” said Dr. Perrone. “Some people like the feeling of being on opioids and, if that prescription runs out, they may try to buy something on the street. But these drugs are often not what people think they are—and that’s where we see a lot of fatal overdoses.”

If you’ve had a prescription for opioid medication that’s run out, and you feel like you can’t stop taking the pills “this could suggest that you need treatment for a substance use disorder,” said Alan.

If you or someone you know struggles with substance abuse, seek help by contacting the national helpline for the Substance Abuse and Mental Health Services Administration (SAMHSA) at 800-662-HELP (4357).