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2022 CDC Guidelines On Opioid Prescribing: Key Highlights

The 2022 CDC Clinical Practice Guideline for Prescribing Opioids gives providers the benefit of the doubt and preserves their discretion. It is vital to read and understand the implementation considerations.  

Closing the Gap: Healthcare Professionals Need Better Training in Therapy Initiation  

Recent changes in federal regulations have made it easier for patients to access buprenorphine for treating acute and chronic pain as well as opioid dependence.   

However, many clinicians may not know how to start therapy properly, including administering micro-doses for sickle cell (SCD) disease care or how to use it for chronic pain management and palliative care. They might also be unaware of the new CDC guidelines for prescribing opioids and lack knowledge about treating opioid use disorder (OUD).  

When did the CDC change the opioid guidelines?  

In 2016, the CDC issued guidelines for chronic pain, but they were controversial and often misapplied by doctors, harming patients. One critical issue was the inappropriate use of dosage recommendations for patients on medication-assisted treatment for opioid use disorder (OUD).  

Now, the CDC has updated these guidelines to strike a balance between minimizing long-term opioid risks and allowing clinician judgment in tailored treatment plans. Prioritizing non-opioid options aims to curb prescription opioid misuse and overdose consequences. Clinicians must stay updated through continuing medical education to assist OUD patients and prevent drug misuse.  

What are the new guidelines for prescribing opioids?

Recent adjustments to opioid prescribing guidelines prioritize mitigating misuse risks and promoting alternative treatments for pain management.  

1. Non-Opioid Prioritization:  

  • Opioids are still no longer first-line therapy for subacute or chronic pain.  

  • Exercise, physical therapy, and other non-opioid interventions are favored. 

2. Comprehensive Evaluation:  

  • Clinicians must assess opioid therapy effectiveness, set treatment goals, and review potential medication interactions.  

3. Exit Strategy Implementation:  

  • Initiation of opioid therapy requires a clinician-established exit strategy.  

4. Tailored Support Programs:  

  • Recommendations include tailored care and cost assistance for appropriate pharmacotherapy, psychological support, and physical therapy.  

These guideline updates emphasize a shift towards safer and more comprehensive pain management strategies, reducing reliance on opioids and enhancing patient care.   

What are the approved medications indicated for the treatment of opioid use disorder (OUD)?  

Approved medications for treating opioid use disorder (OUD) and preventing relapse include buprenorphine, methadone, and naltrexone. These medications, combined with counseling and psychosocial support, offer safe and effective pathways to recovery.  

Buprenorphine:  

  1. Mechanism: Partial agonist at the mu-opioid receptor, antagonist of the kappa-opioid receptor, and agonist of opioid-like-1 receptor.  

  2. Accessibility: Can be prescribed and dispensed in a clinician’s office, enhancing treatment accessibility.  

  3. Functionality: Eases withdrawal, reduces rewarding effects of opioids if used concurrently, and causes less respiratory depression compared to full agonists. 

  4. Formulations: These are available alone or with naloxone to deter injection.  

  5. Treatment Approach: Should be part of a comprehensive treatment plan, including counseling.  

Naloxone:  

  1. Mechanism: Opioid antagonists rapidly reverse respiratory depressive symptoms of opioid overdose.  

  2. Accessibility: Available without a prescription, crucial for family members and caregivers of OUD patients.  

  3. Formulations: Intranasal and injectable formulations.  

  4. Impact: Essential in mitigating the opioid overdose crisis.  

Methadone:  

  1. Mechanism: Synthetic opioid agonist activates mu-opioid receptors.  

  2. Functionality: Occupies mu-opioid receptors, alleviating withdrawal and attenuating euphoria.  

  3. Accessibility: Administered in certified opioid treatment programs (OTPs) for outpatient treatment, requiring daily in-person visits.  

Naltrexone:  

  1. Mechanism: Mu-opioid receptor antagonist blocks the euphoric and analgesic effects of opioids.  

  2. Formulations: Extended-release injectable suspension or oral tablet.  

  3. Challenges: Requires medically supervised withdrawal followed by 7-10 without opioids before initiation to avoid precipitating severe withdrawal symptoms.  

  4. Considerations: Long-acting monthly injections are suitable for patients with adherence challenges; oral tablets are a good option for patients who prefer oral.  

Medication-assisted treatment, combined with counseling and support, offers effective strategies for managing OUD and preventing relapse. Understanding the mechanisms and considerations of buprenorphine, naloxone, methadone, and naltrexone aids in tailoring treatment approaches to individual patient needs.  

The Takeaway  

Opioid use is widespread in pain management, but it's imperative to address concerns about addiction and potential adverse effects. Recent adjustments to federal regulations concerning buprenorphine prescribing have notably enhanced patient access to this agent for managing both acute and chronic pain, as well as opioid dependence.   

Consequently, healthcare professionals must be well-versed in how to thoughtfully consider and integrate opioids, including buprenorphine, into their clinical practice. Furthermore, healthcare professionals would greatly benefit from education on appropriately initiating therapy, implementing micro-induction techniques in sickle cell disease (SCD) care, and leveraging these agents for managing chronic pain and meeting palliative care needs.  

Additional resources for applying the updated 2022 CDC Clinical Practice Guideline for Prescribing Opioids

jesse.clasen@informa.com

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