NEW YORK (AP) — The nation’s top public health agency on Thursday softened its guidelines for U.S. doctors prescribing oxycodone and other opioid painkillers.
The Centers for Disease Control and Prevention’s new recommendations are an update to 2016 guidelines that added momentum to a decline in opioid painkiller prescriptions.
Opioid painkillers can be addictive — even when used under doctors’ orders — and were identified as a big reason for a rise in U.S. drug overdoses that began more than two decades ago. Other drugs have overtaken them in overdose statistics, and illicit fentanyl is now the biggest driver of deaths.
The previous guidance succeeded in reducing inappropriate and dangerous prescribing, some experts say. But they also were seen as a barrier to care, with some pharmacists refusing to fill prescriptions as doctors wrote them.
The new guidelines are designed to ensure that patients get compassionate and safe pain care, CDC officials said.
A draft released in February received 5,500 public comments. Some modifications were made, but several main changes stayed in place, including:
—The CDC no longer suggests trying to limit opioid treatment for acute pain to three days.
—The agency is dropping the specific recommendation that doctors avoid increasing dosage to a level equivalent to 90 milligrams of morphine per day.
—For patients receiving higher doses of opioids, the CDC is urging doctors to not abruptly halt treatment unless there are indications of life-threatening danger. The agency offers suggestions on tapering patients off the drugs.
Dr. William Becker, an internist with the Yale School of Medicine, said that doctors initially took the old guidelines as a call to quickly taper people off their medications. That decision, he said left some patients “in the lurch.”
“Some people even went out on the streets and started using illicit opioids because of these rapid tapers,” he said.
However, he said the old guidelines may have been strong, but did force doctors to examine how they prescribed pain medication.
“So, the new guidelines are saying, let’s everybody slow down, and have individualized care of our patients,” Becker said. “We need to have conversations with them. We need not to do anything drastic.”
Lower back pain is the top reason opioids are prescribed, he said, and research shows those patients do better with a longer taper period.
“The interesting thing is when we go slow and we give people flexibility, they tend to do extremely well, and they often say, ‘I don’t even notice the difference,’ and when we’re at the end of all this, they say they feel better in many cases,” Becker said.
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.