Summary: CDC Guidelines for Prescribing Opioids for Pain

On November 4, the CDC released its guidelines CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022 which updates the CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. The guidelines include recommendations for clinicians who are prescribing opioids for outpatients ≥18 years with acute, subacute, and chronic pain and is a voluntary guidance for clinicians that was created to help inform decision making. The recommendations do not apply to pain related to sickle cell disease or cancer or to patients receiving palliative or end-of-life care.
The recommendations found in the clinical practice guidelines can be summarized by the following actions:

Determining whether or not to initiate opioids for pain
Selecting opioids and determining opioid dosages
Deciding duration of initial opioid prescription and conducting follow-up
Assessing risk and addressing potential harms of opioid use
Consider discussing potential toxicology testing programs to detect therapeutic opioid use

This clinical practice guideline is intended to:

Improve communication between clinicians and patients about the benefits and risks of pain treatments, including opioid therapy
Improve the effectiveness and safety of pain treatment
Mitigate pain
Improve function and quality of life for patients with pain
Reduce risks associated with opioid pain therapy, including opioid use disorder, overdose, and death

The clinical practice guideline includes five guiding principles that should broadly inform implementations of the recommendations:

Acute, subacute, and chronic pain needs to be appropriately assessed and treated independent of whether opioids are part of a treatment regimen.
Recommendations are voluntary and are intended to support, not supplant, individualized, person-centered care. Flexibility to meet the care needs and the clinical circumstance of a specific patient is paramount.
A multimodal and multidisciplinary approach to pain management attending to the physical health, behavioral health, long-term services and supports, and expected health outcomes and well-being of each person is critical.
Special attention should be given to avoid misapplying this clinical practice guideline beyond its intended use or implementing policies purportedly derived from it that might lead to unintended and potentially harmful consequences for patients.
Clinicians, practices, health systems, and payers should vigilantly attend to health inequities; provide culturally and linguistically appropriate communication, including communication that is accessible to persons with disabilities; and ensure access to an equitable, appropriate, affordable, diversified, coordinated, and effective nonpharmacologic and pharmacologic pain management regimen for all persons.

The guidance is voluntary and emphasizes the importance of individualized patient care and should not be applied as inflexible standards of care across patient populations. The guidelines are not a replacement for clinical judgment or individualized, person-centered care, and are not intended to be applied as inflexible standards of care across patients, and/or a law, regulation, and/or policy that dictates clinical practice.