CDC Tries to Put the Brakes on Runaway Opioid Use

Up to 20% of patients presenting with noncancer pain walk out of physician offices with a prescription for an opioid. Too many of them become addicts or abuse prescription painkillers, sometimes with deadly results. With its expectation that encounters will be a one-off, urgent care is an especially appealing target for those looking for a quick fix. Now the Centers for Disease Control and Prevention (CDC) wants all prescribers to think long and hard before prescribing opioids, and has issued a new guideline to help them assess when they’re appropriate. Cancer, palliative, and end-of-life care are all exempt from the new recommendation. Beyond that, the guidelines push a stepwise approach wherein nonopoid pain therapies are tried first; that scenario would be the norm in urgent care. If opioids are truly necessary, the lowest possible effective dose should be given. The guideline’s 12 recommendations can be summed up as supporting three broad approaches: when to initiate or continue opioids for chronic pain; selection, dosage, duration, follow-up, and discontinuation; and assessing risk and possible harms of opioid use. The full guideline was published in Morbidity and Mortality Weekly Report and is available on the CDC website (http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm).