Expert from CDC Stakeholder Group: Educating Primary Care is Essential

On March 16, 2016 the Centers for Disease Control (CDC) released its long-awaited Guideline for Prescribing Opioids for Chronic Pain. The guideline was developed to provide recommendations about opioid prescribing for primary care clinicians treating adult patients with chronic noncancer pain and outside of palliative and end-of-life care. The guideline is intended to improve communication about the benefits and risks of opioids for chronic pain, improve safety and effectiveness of pain treatment, and reduce risks associated with long-term opioid therapy. Asokumar Buvanendran, MD, a participant on the CDC Stakeholder Review Group that informed the development of the guideline, observed that effectively addressing the issue of opioid misuse and addition must begin with educating primary care practitioners about the safe and effective alternatives to opioids that are available. "It is vital that providers only consider adding opioid therapy if expected benefits for both pain and function outweigh risks to the patient." He says, "Understanding that there are alternatives to opioids greatly informs that consideration".

Among the recommendations contained in the CDC Guideline:

  • Nonopioid therapy is preferred for treatment of chronic pain
  • Before prescribing opioids, clinicians should:
    • establish treatment goals with patients
    • consider how opioids will be discontinued if benefits do not outweigh risks
  • Prescribers should:
    • engage the lowest effective dose
    • avoid concurrent use of opioids and benzodiazepines
    • reassess continued opioid therapy every 3 months or more often
  • For patients with opioid use disorder, clinicians should offer or arrange evidence-based treatment, such as medication-assisted treatment with buprenorphine or methadone.

The Stakeholder Review Group additionally noted that a barrier to clinicians’ use of nonopioid therapies stems from insurance companies’ failure to cover them, and recommended that CDC use its influence to alter this situation.

To access the library of information about opioids, click here.

A news story with commentary from Dr. Buvanendran may be read here.

A link to the CDC Guideline for Prescribing Opioids for Chronic Pain may be found here.

A special communication on the CDC guideline from the Journal of the American Medical Association (JAMA) may be found here.

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