Prepared for RSDSA by James Doulgeris – for more information or with questions, contact him directly at [email protected]
The restrictive guidelines for opiate prescribing of the past have been relaxed substantially, leaving decision making to physicians and their patients. Here are the details:
The new guidelines for prescribing opioids, as outlined by the Centers for Disease Control and Prevention (CDC), have evolved to address the opioid crisis while ensuring appropriate pain management. These guidelines were updated in 2022 and focus on several key areas:
- Determining the Need for Opioids: Healthcare providers should carefully evaluate the necessity of opioids for pain management. Non-opioid alternatives should be considered first, especially for conditions like chronic pain .
- Patient Assessment: Before prescribing opioids, healthcare professionals should assess the patient’s medical history, risk factors for addiction, and pain intensity. They should discuss the risks and benefits with the patient and establish treatment goals .
- Prescribing Opioids Responsibly: When opioids are deemed necessary, providers should start with the lowest effective dose for the shortest duration, particularly for acute pain. For chronic pain, they should use a gradual titration approach and regularly reassess the patient’s progress.
- Monitoring and Follow-Up: Ongoing monitoring is essential, with regular follow-ups to evaluate the patient’s response to opioids, their adherence, and any signs of misuse or addiction. Adjustments to the treatment plan should be made as needed .
- Education and Informed Consent: Healthcare providers should educate patients about the potential risks and benefits of opioid therapy and obtain informed consent. They should discuss the safe use, storage, and disposal of opioids .
- Flexibility: The guidelines emphasize flexibility, recognizing that each patient’s situation is unique. The approach to opioid prescribing should be tailored to individual needs and circumstances .
It’s important to note that these guidelines aim to strike a balance between providing pain relief for those who need it while mitigating the risks of opioid misuse and addiction, contributing to efforts to combat the opioid epidemic.
- CDC Clinical Practice Guideline for Prescribing Opioids (2022)
- NEJM – Prescribing Opioids for Pain — The New CDC Clinical Practice Guideline
- New Opioid Prescribing Guideline Emphasizes Flexibility
- Full CDC policy on Continuing Opioid Therapy
Overall, while CDC guidelines are more liberal, many state guidelines have failed to be updated to reflect more modern medical viewpoints. Some states such as Colorado are so restrictive that they have only begun to update their ban on opiates when confronted with hard evidence of a direct link to the ban and suicide rates.
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