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December 19, 2019

New Guidelines Coming for Prescribing Opioids to Treat Acute Pain

The Centers for Disease Control and Prevention (CDC) guideline for prescribing opioids to treat chronic pain has become a hot topic as the nation continues combating the opioid epidemic. The 2016 guideline makes numerous recommendations that are mainly targeted at primary care physicians and other specialists who manage patients with chronic pain—not emergency physicians who mainly treat patients with acute pain. (In fact, the guideline references third-party prescribing recommendations within acute care settings, such as ACEP’s guideline for prescribing opioids in the ED.)

Recently, the CDC held a public meeting where it announced its intention to update the guideline to include up-to-date clinical evidence and best practices. During the meeting, there was a robust discussion from a clinical panel of physicians and other health care practitioners about how the current guideline had been misinterpreted—as well as numerous public comments from patients supporting that assertion. According to the first-hand, extremely personal accounts from patients with chronic pain, the guideline caused their physicians to stop refilling their prescriptions—exacerbating their pain and leading to other negative health outcomes. Even though the guideline clearly does not state that physicians should stop prescribing opioids cold turkey, according to many patients, that’s exactly what has been happening.

At the end of the public meeting, the small clinical panel within the CDC voted to revise the guideline and do more to ensure that it is not misinterpreted going forward. However, that is not all they want to do.

The CDC also wants to expand the guideline to address the treatment of acute pain—which will affect most of you. This new guideline would establish overall opioid prescribing recommendations for the treatment of acute pain in all settings.

The CDC plans to establish a workgroup that it will charge with both updating the existing opioid prescribing guideline for chronic pain and developing a new one for acute pain. Having an emergency medicine representative on the workgroup will be critical. Overall, we want the new guideline for acute pain to be evidence-based but provide enough flexibility to allow for appropriate clinical judgment and to account for the unique nature of care that is provided in EDs.

Although the CDC announced its intention to create the workgroup, the agency has not yet officially released any information about it. I will keep you updated as we learn more details about the workgroup and the CDC’s ongoing effort to revise opioid prescribing guidelines.

Until next week, this is Jeffrey saying, enjoy reading regs with your eggs!

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