CDC guideline for prescribing opioids for chronic pain

In 2012 prescribers in the United States wrote 259 million opioid prescriptions, and per-capita prescribing had risen 7.3 percent from 2007, with wide differences between states. From 1999 to 2014 more than 165,000 people died of overdoses related to opioid pain medication.

The guideline, by Deborah Dowell, Tamara Haegerich and Roger Chou, appeared in CDC's Morbidity and Mortality Weekly Report on 18 March 2016. Its 12 recommendations said that nonpharmacologic therapy and non-opioid drugs were preferred for chronic pain, and that opioids should be started only when expected benefits for pain and function outweighed the risks, combined with other treatments and tied to realistic goals. It advised the lowest effective dose, careful reassessment before raising it to 50 morphine milligram equivalents a day or more, and avoiding 90 or more or carefully justifying it, and said that three days or less would often be enough for acute pain, with more than seven rarely needed. Clinicians were told to check prescription drug monitoring program data, consider urine drug testing and naloxone, and arrange methadone or buprenorphine treatment for patients with opioid use disorder. The guideline also warned that combining opioids with benzodiazepines raised the risk of fatal overdose.

CDC's 2022 revision described what followed. The 2016 release was associated with faster declines in overall opioid prescribing and in high-risk prescribing, such as high doses and opioids given with benzodiazepines, and with modest increases in non-opioid pain prescriptions. Some policies said to be drawn from the guideline went well beyond it. According to CDC, rapid tapers, abrupt discontinuation without the patient's involvement, rigid dose thresholds and dismissal of patients from care contributed to untreated pain, serious withdrawal, psychological distress, overdose and suicidal thoughts.