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Opioid prescribing guidelines set to change as Centers for Disease Controls probes practices

Primary care providers say they receive insufficient training in prescribing opioid pain relievers, according to the CDC.

Susan Morse, Associate Editor

Doctors, providers and other stakeholders have until end of day Monday, Jan. 11,  to submit comment on new Centers for Disease Control and Prevention guidelines for prescribing opioids for chronic pain. The comments are to be submitted ahead of a National Center for Injury Prevention and Control Board of Scientific Counselors meeting on Thursday, January 28, for the development of a primary care provider guideline to help reduce the misuse, abuse, and overdose from opioids, the CDC said.

Public comment is also being taken during the meeting.

More than 16,000 people in the United States died in 2013 from overdoses related to opioid pain relievers, four times the number in 1999, the CDC said.

[Also: Medicare plans favoring generic opioids despite abuse statistics, study finds]

Prescription opioid sales in the United States have increased by 300 percent since 1999, but there has not been an overall change in the amount of pain Americans report, according to the CDC.

The epidemic of heroin overdoses has come to the forefront as a medical and political issue, with some users of the illegal opioid having started out as addicts of prescription pain medication.

Primary care providers say they receive insufficient training in prescribing opioid pain relievers, according to the CDC.

The new guideline will provide recommendations about the appropriate prescribing of opioid pain medications in treating chronic pain lasting longer than three months or past the time of normal tissue healing. The guideline is not intended for patients who are in active cancer treatment, palliative care, or end-of-life care, the CDC said.

[Also: As epidemic grows, the cost of drug addiction weighs on hospital finances]

The American Medical Association made recommendations, but for some of the goals to be achieved, public and private payer policies must change, said Executive Vice President and CEO Dr. James Madara said in an October 1 letter to the CDC.

The AMA is expected to issue an updated comment this week, it said.

One recommendation the organization made in October was for opioids to be considered only if the expected benefits for both pain are function outweighed risk.

"In order to achieve this goal, public and private payer policies must be fundamentally altered and aligned in support," Madara said. "In addition, more evidence must be developed to inform clinical decision-making on the use of non-pharmacologic approaches, and more clinicians need to be trained in their effective use."

Providers should initiate opioid therapy at the lowest effective dose, the AMA said. They should offer or arrange evidence-based treatment in combination with behavioral therapies for patients with opioid use disorder, the AMA said.

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To do this, more clinicians need to be trained and government funding, as well as public and private payer policies must be fundamentally altered and aligned in support of expanded access to treatment, the AMA said.

The AMA also expressed concern that the methodology used by the CDC was built on systematic reviews conducted in 2009 and 2014. 

"What is not explained is that the inclusion criteria for efficacy studies was changed from a 'best evidence' approach in 2009 to a requirement for a study duration of one year for the 2014 review, thereby eliminating virtually all of the controlled, opioid-based, efficacy studies," the AMA said in October. "Given that chronic pain is defined as pain persisting for at least three months or beyond the expected time of tissue healing, this approach may introduce a selection bias regarding adverse events and harms."

Twitter: @SusanJMorse

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