Which parts of the 2016 CDC Guidelines are reasonable and necessary to suspend during a pandemic?
Considering Whether to Use Opioids for Chronic Pain Management
Recommendation 1. Prioritize nonpharmacologic and nonopioid pharmacologic pain management strategies, unless the expected benefits of opioids for both pain and function are anticipated to outweigh risks to the patient.
Recommendation 2. Establish treatment goals with patients that include realistic pain and function objectives. Ensure that patients understand that opioid therapy will only continue if there is a clinically meaningful improvement in pain and function that outweighs the risks.
Recommendation 3. Ensure that patients understand the risks and realistic benefits of opioid therapy and the responsibilities of both patient and clinician for managing therapy.
Prescribing Opioids for Chronic Pain Management
Recommendation 4. Prescribe immediate-release opioids instead of extended-release/long-acting (ER/LA) opioids when starting opioid therapy.
Recommendation 5. Use caution when prescribing any dosage of opioids. Prescribe the lowest effective dosage when starting opioid therapy and when planning to increase the dosage to ≥50 morphine milligram equivalents (MME)/day, assess the patient’s benefits versus the harms of being on the new dose. Avoid increasing dosage to ≥90 MME/day or appropriately justify a decision to do so.
Recommendation 6. When opioids are used to treat a patient in acute pain, prescribe the lowest effective dose of immediate-release opioids in no greater quantity than needed for the expected duration of pain. In most cases, this will be three days or less, and rarely over seven days.
Regularly Assessing the Harms and Benefits of Opioids in Chronic Pain Management
Recommendation 7. Conduct a harm/benefit analysis with the patient within one to four weeks of starting opioid therapy or of dose escalation, and at least every three months thereafter. When benefits do not outweigh harms, optimize other therapies and taper to lower dosages or discontinue opioids.
Mitigating Overdose Risk
Recommendation 8. Regularly evaluate the patient’s overdose risk and incorporate strategies to mitigate risk in the patient’s pain management plan, for example, by offering Naloxone.
Recommendation 9. Regularly review prescription drug monitoring program (PDMP) data when starting opioids and periodically during treatment to determine whether the patient is receiving opioid dosages or dangerous combinations that put him or her at high risk for overdose.
Recommendation 10. Regularly use urine drug testing to assess for prescribed medications as well as other controlled prescription drugs and illicit drugs.
Recommendation 11. Avoid prescribing opioid pain medication and benzodiazepines concurrently whenever possible.
Treating Opioid Use Disorder
Recommendation 12. Offer or arrange treatment for patients with opioid use disorder.
Considering Whether to Use Opioids for Chronic Pain Management
Recommendation 1. Prioritize nonpharmacologic and nonopioid pharmacologic pain management strategies, unless the expected benefits of opioids for both pain and function are anticipated to outweigh risks to the patient.
Recommendation 2. Establish treatment goals with patients that include realistic pain and function objectives. Ensure that patients understand that opioid therapy will only continue if there is a clinically meaningful improvement in pain and function that outweighs the risks.
Recommendation 3. Ensure that patients understand the risks and realistic benefits of opioid therapy and the responsibilities of both patient and clinician for managing therapy.
Prescribing Opioids for Chronic Pain Management
Recommendation 4. Prescribe immediate-release opioids instead of extended-release/long-acting (ER/LA) opioids when starting opioid therapy.
Recommendation 5. Use caution when prescribing any dosage of opioids. Prescribe the lowest effective dosage when starting opioid therapy and when planning to increase the dosage to ≥50 morphine milligram equivalents (MME)/day, assess the patient’s benefits versus the harms of being on the new dose. Avoid increasing dosage to ≥90 MME/day or appropriately justify a decision to do so.
Recommendation 6. When opioids are used to treat a patient in acute pain, prescribe the lowest effective dose of immediate-release opioids in no greater quantity than needed for the expected duration of pain. In most cases, this will be three days or less, and rarely over seven days.
Regularly Assessing the Harms and Benefits of Opioids in Chronic Pain Management
Recommendation 7. Conduct a harm/benefit analysis with the patient within one to four weeks of starting opioid therapy or of dose escalation, and at least every three months thereafter. When benefits do not outweigh harms, optimize other therapies and taper to lower dosages or discontinue opioids.
Mitigating Overdose Risk
Recommendation 8. Regularly evaluate the patient’s overdose risk and incorporate strategies to mitigate risk in the patient’s pain management plan, for example, by offering Naloxone.
Recommendation 9. Regularly review prescription drug monitoring program (PDMP) data when starting opioids and periodically during treatment to determine whether the patient is receiving opioid dosages or dangerous combinations that put him or her at high risk for overdose.
Recommendation 10. Regularly use urine drug testing to assess for prescribed medications as well as other controlled prescription drugs and illicit drugs.
Recommendation 11. Avoid prescribing opioid pain medication and benzodiazepines concurrently whenever possible.
Treating Opioid Use Disorder
Recommendation 12. Offer or arrange treatment for patients with opioid use disorder.
