CDC proposes softer steering on opioid prescriptions

The Facilities for Illness Management and Prevention’s earlier steering, issued six years in the past, helped gradual the form of prescribing that ignited the worst overdose epidemic in U.S. historical past. But it surely additionally induced some medical doctors to develop into too fast to chop off sufferers taking prescription painkillers and too strict in holding the medication from sufferers who would possibly profit, CDC officers stated.

“We started to listen to how the rules have been being misused and misapplied” stated the CDC’s Christopher Jones, a co-author of the draft steering.

The proposed adjustments, contained in a 229-page draft replace within the Federal Register, would roll again some prompt limits on the medication. Their publication opens a 60-day public remark interval. The CDC will take into account feedback earlier than finalizing the up to date steering.

The final intent is to foster individualized affected person care, Jones stated. It additionally provides extra choices for treating the form of short-term, acute ache that follows surgical procedures or accidents.

One professional expressed preliminary wariness a couple of proposed revision.

The 2016 steering succeeded in serving to to scale back inappropriate and harmful prescribing, stated Dr. Adriane Fugh-Berman of Georgetown College Medical Heart. Its critics have included ache sufferers, but in addition painkiller producers and teams they fund, she stated.

“There was nothing flawed with the unique tips,” stated Fugh-Berman, a paid professional witness for plaintiffs in circumstances focusing on pharmaceutical advertising and marketing practices.

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

Mukkamala stated the rules have been a barrier to affected person care, with some pharmacists pointing to the CDC’s prompt limits and refusing to fill prescriptions as medical doctors wrote them.

“That is disastrous for sufferers in ache,” stated Mukkamala, chairman of the American Medical Affiliation board of trustees.

Opioids will be an necessary instrument in treating extreme ache from most cancers, surgical procedure and critical accidents. However additionally they will be addictive — even when used beneath medical doctors’ orders.

Starting within the Nineteen Nineties, some drugmakers, insurers and ache specialists referred to as for wider use of the medication for extra frequent illnesses like backaches and arthritis. The push was tied into the advertising and marketing of medication like OxyContin, which have been billed as much less addictive than different opioids.

When U.S. overdose deaths started skyrocketing, prescription painkillers have been recognized as a giant cause. Governments tried to limit the prescriptions, however the overdose epidemic worsened as individuals hooked on drugs switched to heroin after which to fentanyl. These sorts of unlawful injected medication are actually related to nearly all of U.S. overdose deaths.

The CDC’s 2016 prescribing tips stated opioids shouldn’t be the primary remedy for power ache. Docs have been urged to first attempt different drugs or nondrug choices, restrict opioid prescriptions for short-term ache to a few days, and to prescribe the bottom efficient dose attainable.

The rules are voluntary, however they have been extensively adopted and added momentum to a dramatic decline in opioid painkiller prescriptions.

Additionally they got here beneath assault from ache sufferers and drug producers, who argued some individuals in extreme ache have been being denied wanted reduction.

In 2019, CDC officers signaled that they have been involved about these stories. They examined newer analysis, ensuing within the new proposal, Jones stated. Drugmakers had no enter into the writing of the draft revision, he stated.

Modifications embody:

—The CDC would not recommend making an attempt to restrict opioid remedy for acute ache to a few days.

—The company would drop the particular suggestion that medical doctors keep away from growing dosage to a degree equal to 90 milligrams of morphine per day.

—The CDC would say medical doctors ought to take into account having sufferers endure urine assessments to see if they’re utilizing different managed and illicit medication, however not would name on having such testing carried out yearly.

—For sufferers receiving increased doses of opioids, the CDC would urge medical doctors to not abruptly halt remedy until there are indications of a life-threatening hazard. The company would supply ideas about the way to taper sufferers off the medication.


The Related Press Well being and Science Division receives assist from the Howard Hughes Medical Institute’s Division of Science Training. The AP is solely answerable for all content material.