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Substance use disorders

Informing CDC opioid prescribing guidelines

Division leaders partner with APA Services to respond to the Centers for Disease Control and Prevention’s proposed update of guidelines for use of prescription opioids in pain management.

Cite this
American Psychological Association. (2022, April 19). Informing CDC opioid prescribing guidelines. https://www.apaservices.org/advocacy/news/opioid-prescribing-guidelines

picture of a handwritten prescription

Pain psychologists in APA Divisions 38, 50, 12, and 22 worked with APA Services staff to develop comments on the Centers for Disease Control and Prevention’s (CDC) proposed 2022 Guideline for Prescribing Opioids for Chronic Pain. The APA Services federal comment letter (PDF, 230KB) applauded the agency for several of the proposed modifications, including clarification that the guideline should not be interpreted as an inflexible standard of care, and the expansion and clarification of the intended audience for the guideline to include providers in addition to primary care physicians.

The letter recommended the guideline include stronger statements regarding coverage and reimbursement barriers to the use of nonpharmacological, integrative, and non-opioid pain management, and a clear recommendation for patient referral for psychological assessment and mental health evaluation prior to initiating long-term opioid treatment. It also urged the addition of recommendations for clinician attention to continuing racial, ethnic, and gender disparities in pain identification and treatment, and the stigmatization of individuals with opioid use disorders and lack of access to treatment. The input of pain psychology and addiction subject matter experts on these and other recommendations has been invaluable, and their collective contributions supported a high-quality, evidence-based submission.

Rates of opioid prescribing in the U.S. increased fourfold between 1999 and 2010, and not coincidentally, this period saw a nearly fourfold increase in drug overdose deaths involving prescription opioids (Paulozzi, Jones, Mack, & Rudd, 2011). While most drug overdose deaths involve a synthetic opioid such as fentanyl, use of prescription opioids is a significant risk factor for developing an opioid use disorder (Vowles, et al., 2015). In response to the growing opioid overdose crisis, the CDC published a Guideline for Prescribing Opioids for Chronic Pain in 2016 (PDF, 715KB), which contributed to a significant decline in the prescription of opioids for treating pain.

Earlier this year, the CDC released a proposed update of the 2016 guideline, citing new evidence on the risks and benefits of prescription opioids for treating acute and chronic pain and on nonpharmacological and nonopioid pain treatments, as well as concerns that the 2016 guideline was resulting in inappropriate and dangerous restrictions on access to opioids for some patients. Despite declines from earlier prescribing levels, opioids remain commonly used, and in 2020 an estimated 143 million opioid prescriptions were dispensed from pharmacies in the United States (Centers for Disease Control and Prevention, 2021).

For more information contact Scott Barstow.

References

Paulozzi, L., Jones, C., Mack, K., & Rudd, R. (2011). Vital signs: overdoses of prescription opioid pain relievers---United States, 1999--2008. MMWR Morb Mortal Wkly Rep, 60(43), 1487-1492.

Vowles, K. E., McEntee, M. L., Julnes, P. S., Frohe, T., Ney, J. P., & van der Goes, D. N. (2015). Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis. Pain, 156(4), 569-576. doi:10.1097/01.j.pain.0000460357.01998.f1