CDC proposes softer guidance on opioid prescriptions

[IceWizard]

CDC proposes softer guidance
on opioid prescriptions


The nation’s top public health agency is proposing
changing — and in some instances, softening — guidelines
for doctors prescribing opioid painkillers


By MIKE STOBBE AP Medical Writer
February 10, 2022, 2:20 PM



FILE - This June 17, 2019, file photo shows 5-mg pills of Oxycodone.
The nation's top public health agency on Thursday proposed
changing — and in some instances, dulling — guidelines for U.S. doctors
prescribing oxycodone and other opioid painkillers.
(AP Photo/Keith Srakocic, File)




NEW YORK

The nation's top public health agency on Thursday proposed changing — and in
some instances, softening — guidelines for U.S. doctors prescribing oxycodone
and other opioid painkillers.

The Centers for Disease Control and Prevention's previous guidance, issued six
years ago, helped slow the kind of prescribing that ignited the worst overdose
epidemic in U.S. history. But it also caused some doctors to become too quick to
cut off patients taking prescription painkillers and too strict in keeping the drugs
from patients who might benefit, CDC officials said.

“We began to hear how the guidelines were being misused and misapplied" said
the CDC's Christopher Jones, a co-author of the draft guidance.

The proposed changes, contained in a 229-page draft update in the Federal Register,
would roll back some suggested limits on the drugs. Their publication opens a 60-day
public comment period. The CDC will consider comments before finalizing the updated guidance.

The general intent is to foster individualized patient care, Jones said. It also offers
more options for treating the kind of short-term, acute pain that follows surgeries or injuries.

One expert expressed initial wariness about a proposed revision.

The 2016 guidance succeeded in helping to reduce inappropriate and dangerous
prescribing, said Dr. Adriane Fugh-Berman of Georgetown University Medical Center.
Its critics have included pain patients, but also painkiller manufacturers and groups
they fund, she said.

“There was nothing wrong with the original guidelines,” said Fugh-Berman,
a paid expert witness for plaintiffs in cases targeting pharmaceutical marketing practices.

Dr. Bobby Mukkamala, a head and neck surgeon in Flint, Michigan, welcomed the update.

Mukkamala said the guidelines have been a barrier to patient care, with some pharmacists
pointing to the CDC's suggested limits and refusing to fill prescriptions as doctors wrote them.

“That's disastrous for patients in pain,” said Mukkamala, chairman of the
American Medical Association board of trustees.

Opioids can be an important tool in treating severe pain from cancer, surgery and
serious injuries. But they also can be addictive — even when used under doctors’ orders.

Beginning in the 1990s, some drugmakers, insurers and pain specialists called for
wider use of the drugs for more common ailments like backaches and arthritis.
The push was tied into the marketing of drugs like OxyContin, which were billed
as less addictive than other opioids.

When U.S. overdose deaths began skyrocketing, prescription painkillers were
identified as a big reason. Governments tried to restrict the prescriptions, but
the overdose epidemic worsened as people hooked on pills switched to heroin
and then to fentanyl. Those kinds of illegal injected drugs are now associated
with the majority of U.S. overdose deaths.

The CDC's 2016 prescribing guidelines said opioids should not be the first treatment
for chronic pain. Doctors were urged to first try other medications or nondrug options,
limit opioid prescriptions for short-term pain to three days, and to prescribe the
lowest effective dose possible.

The guidelines are voluntary, but they were widely adopted and added momentum
to a dramatic decline in opioid painkiller prescriptions.

They also came under attack from pain patients and drug manufacturers, who argued
some people in severe pain were being denied needed relief.

In 2019, CDC officials signaled that they were concerned about those reports.
They examined newer research, resulting in the new proposal, Jones said.
Drugmakers had no input into the writing of the draft revision, he said.



Changes include:


—The CDC would no longer suggest trying to
limit opioid treatment for acute pain to three days.

—The agency would drop the specific recommendation
that doctors avoid increasing dosage to a level
equivalent to 90 milligrams of morphine per day.

—The CDC would say doctors should consider
having patients undergo urine tests to see if they
are using other controlled and illicit drugs, but no longer
would call on having such testing done annually.

—For patients receiving higher doses of opioids,
the CDC would urge doctors to not abruptly halt
treatment unless there are indications of a life-threatening
danger. The agency would offer suggestions about how
to taper patients off the drugs.





The Associated Press Health and Science Department
receives support from the
Howard Hughes Medical Institute’s Department of Science Education.
The AP is solely responsible for all content.

[esbayne]

Very useful Ice


Thanks Eddie

[barq2]

I stumbled across this the other day... access to pain management is in the UN Charter of Human Rights. You wouldn't think it from the way pain is(n't) treated in the UK!