The CDC has published sweeping new opioid treatment guidelines that focus on chronic pain management. The guideline is in response to a staggering increase in opioid use nationally and the resultant opioid overdose epidemic. The new guidelines stress that opioids should not be prescribed as first-line therapy for chronic pain but, if needed, should be used with nonpharmacological and non-opioid therapy (the guidelines exclude cancer- and palliative care-related opioid use). The document recommends caution with doses higher than 50 morphine mg equivalent per day (MME/day) and avoiding doses of 90 MME/day. If higher doses cannot be avoided, prescribers need to carefully justify dose escalation due to the increasing risk of harm and overdose with doses > 90 MME/day. Patients initiated on opioids should receive immediate-release products at the lowest effective dose. Physicians should conduct regular reevaluations with assessment of risks and benefits at least every 3 months. State prescription databases should be used to determine whether patients are receiving opioids from other sources or are taking dangerous combinations such as opioids with benzodiazepines (a combination that should be avoided whenever possible). For treatment of acute pain, 3 days of therapy is usually sufficient and more than 7 days is rarely needed. Patients with opioid use disorder should be offered an evidence-based treatment such as methadone or buprenorphine. Naloxone should be considered for patients at high risk of overdose (JAMA. Published online March 15, 2016. doi:10.1001/jama.2016.1464; MMWR March 18, 2016).
The White House has also announced measures to combat opioid abuse, including increasing the patient limit for clinicians who prescribe buprenorphine for addiction from 100 to 200, providing training for buprenorphine prescribers, and expanding substance use disorder treatment services, particularly in underserved populations.
Meanwhile, several states have taken action individually to curb opioid prescribing. The Massachusetts legislature passed a bill to limit post-surgical opioids to a 7-day supply, and several other New England states are considering similar measures.