In new guidelines, the CDC walks back stringent recommendations for prescribing opioids

The Centers for Disease Control and Prevention this week released new guidelines for prescribing opioids that encourage doctors to work with patients individually when prescribing opioids for pain — instead of applying a rigid, one-size-fits-all approach to patients.

The new guidelines are intended to correct recommendations from 2016 that encouraged doctors to cap dosages and stop treatment after a certain amount of time.

While nonbinding, those recommendations had a significant impact on pain patients who require opioid treatment and influenced policies around the country that led patients to rapidly taper off opioids or abruptly stop using them entirely, increasing their risk of painful withdrawal, the CDC wrote in its new guidelines.

Physician Jeanmarie Perrone, the director of the Division of Medical Toxicology and Addiction Medicine Initiatives at the University of Pennsylvania, served on the working group that helped to write the guidelines. She said the new recommendations encourage doctors to work more closely with patients to determine their needs, instead of arbitrarily capping doses or prescriptions.

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“We’re being a lot more cautious, stating that this is a guideline, and sort of backpedaling from the 2016 guidelines,” Perrone said. “Many clinicians possibly misinterpreted the idea — and instead of just using opioids sparingly, they stopped using opioids.”

Perrone said she was pleased that the CDC recommended that physicians treat opioid use disorder with medications like methadone and buprenorphine — opioids themselves that have been proven to produce more lasting recovery than abstinence-based detox programs. She added that she wished the guidelines had recommended that clinicians consider prescribing buprenorphine for chronic pain.

Unlike methadone and other opioid painkillers like oxycodone, buprenorphine is a partial opioid agonist, meaning that it doesn’t bind as tightly with opioid receptors in the brain, and carries less of a risk of overdose.

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The guidelines still encourage doctors to be judicious about prescribing opioids, to prescribe non-opioid painkillers when possible, and to talk to patients about the risks of addiction and overdose. But, Perrone said, doctors worried that a patient may have a substance use disorder should discuss those concerns with them, not cut them off or deny care.

“It’s about seeing the problem of opioid misuse as a chronic medical problem, not an excuse to stop opioids,” Perrone said.