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http://1.usa.gov/1Z9Vmv7
The Problem
Existing guidelines vary in recommendations, and primary care providers say they receive insufficient training in prescribing opioid pain relievers. It is important that patients receive appropriate pain treatment, and that the benefits and risks of treatment options are carefully considered.
259 million
In 2012, health care providers wrote 259 million prescriptions for opioid pain relievers – enough for every American adult to have a bottle of pills.1
300% increase
Prescription opioid sales in the United States have increased by 300% since 1999,2 but there has not been an overall change in the amount of pain Americans report.3,4
2 million
Almost 2 million Americans, age 12 or older, either abused or were dependent on opioid pain relievers in 2013.5
16 thousand
In 2013, more than 16,000 people died in the United States from overdose related to opioid pain relievers, four times the number in 1999.6
Improving Practice
Improving the way opioids are prescribed through clinical practice guidelines can ensure patients have access to safer, more effective chronic pain treatment while reducing the number of people who misuse, abuse, or overdose from these powerful drugs.
The Centers for Disease Control and Prevention (CDC) is publishing new guideline for prescribing opioids for chronic pain. The agency is working for timely release of the guideline while ensuring that the development process:
Intended Purpose and Use of Guideline
The purpose of the CDC guideline is to provide recommendations for the prescribing of opioid pain medication for patients 18 and older in primary care settings. Recommendations focus on the use of opioids in treating chronic pain (i.e., pain lasting longer than 3 months or past the time of normal tissue healing) outside end-of-life care.
Clinical practices addressed in the guideline
Determining when to initiate or continue opioids for chronic pain outside end-of-life care
- Selection of opioid therapy, non-pharmacologic therapy, non-opioid pharmacologic therapy
- Establishment of treatment goals
- Discussion of risks and benefits of therapy with patients
Opioid selection, dosage, duration, follow-up, and discontinuation
- Selection of extended-release and long-acting opioids
- Dosage considerations
- Duration of treatment for acute pain and chronic opioid use
- Considerations for follow-up and discontinuation of opioid therapy
Assessing risk and addressing harms of opioid use
- Evaluation of risk factors for opioid-related harms and integration into the management plan
- Review of prescription drug monitoring program data
- Use of urine drug testing
- Considerations for concurrent use of opioids and benzodiazepines
- Arrangement of treatment for opioid use disorder
Guideline Development: Methods and Processes
CDC used the Grading of Recommendations Assessment, Development, and Evaluation method to guideline development (www.gradeworkinggroup.org). This method uses a transparent approach to grading quality of evidence and strength of recommendations. Four factors were used to determine the recommendations: 1) quality of evidence, 2) balance between benefits and harms, 3) values and preferences, and 4) costs. CDC also has developed a tiered approach to involve stakeholders in guideline development.
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