New Opioid Prescribing Guidelines
The ethics of pain management has its complexities, as the needs to decrease the use of drugs that pose a potential risk to patients are to be prioritized. Sequel to the implementation of chronic pain management guidelines, the administration of prescription opioids was significantly reduced. The new guidelines for prescribing opioid pain drugs are resources that provide frontline healthcare workers with adequate information on best practices for the administration of opioids.
The CDC opioid prescribing guidelines stand as a recommendation for the appropriate use of the drug among patients age 18 years and above with exceptions to health conditions related to active cancer and terminal illness life care. The 2019 opioid prescribing guidelines address critical issues such as:
- When it is necessary to administer chronic opioid therapy for pain
- Type of opioid, dosage, schedule and discontinuation of the medication
- Comprehensive risk assessment to address problems associated with opioid use
Why Were New Opioid Guidelines Implemented?
Opioid addiction and abuse have become an economic burden in the United States worth $78.5 billion annually. The loss is inclusive of criminal justice, healthcare costs, addiction treatment, reduced productivity, and others. At least 115 lives are lost daily to opioid overdose and other related accidents. Also, an estimate of 165,000 people died from opioid pain med overdose in the United States from 1999 to 2014.
Amidst the problem of addiction and deaths due to misuse of prescribed opiates, many literature reviews have ascertained that the clinical efficacy of prescription opioids is below optimal and yet its adverse effect is pronounced and frequent. Opioid prescribing for acute and chronic pain is associated with more critical consequences. Other medications that have shown as much promise for chronic pain management are the non-steroidal anti-inflammatory drugs (NSAIDs).
Opioid use has also been negatively associated with failed back surgery, increased medical costs, and psychiatric morbidity, among others. The new opioids prescribing guidelines are a necessity to reduce the addiction and abuse rates of the drug.
What are the New Opioid Guidelines?
The guidelines for opioid prescribing developed by the CDC are meant to supplement clinical judgment – for forfeit. The pain management laws for the treatment of non-terminal pain is recommended at 80 mg morphine equivalency dosing (MED), the threshold mitigates the possibilities of overdose as dosages above this may present with critical health issues. Opioid prescribing by the state follows a general guideline in determining when it is appropriate to either initiate or continue the use of opioids for treatment. The guidelines are as follows:
- Non-opioid pharmacological therapy is the first-line medication for chronic pain. Medical practitioners are expected to only consider a combined therapy of low dosage opioids with non-pharmacologic and non-opioid medication if the benefits outweigh the health risks.
- Treatment goals should be pre-established with the patient before the initiation of the medication. Realistic goals should be set, including a discontinuation schedule. The opioid medication should only be continued if the resultant improvement in pain outweighs the risk to the health of the patient.
- Before opioids are administered to patients, medical practitioners are advised to educate patients on the health risks and benefits of opioid medication for pains. The responsibilities of the physician and that of the patient should also be discussed in detail to mitigate the risks of addiction and other complications.
- The type of opioid, the dosage, duration of use, and tentative time of discontinuation should be well stated. Also, for first time users, opioid therapy should start with immediate-release opioids instead of the long-acting or extended-release category of opioids.
- To mitigate the effects of opioids, the starting doses should be the lowest effective dosage. During the period of use, clinicians are expected to reassess risks and benefits to consider increasing the dosage by 50 morphine milligram equivalents (MME)/day on maximum except on well-justified conditions.
- Opioid prescribing, for the long term, often starts with the treatment of acute pains. The duration for the use of opioids in severe pains is three days or less, depending on the situation. A period of seven days of opioid prescription may be possible but very rare.
- The benefits and risks of opioid therapy should be evaluated every 1 to 4 weeks for patients with chronic pain. Continued treatments are to be accessed every three months or less to ascertain that benefits outweigh risks. Clinicians are expected to taper off medications while initiating the discontinuation process.
- Clinicians should incorporate the tendency to offer naloxone to patients with a history of a substance use disorder, especially opioids. This is inclusive for pregnant women, mental health patients, individuals with health impediments such as hepatic and renal insufficiency.
- Opioid pain medications and benzodiazepines should not be prescribed concurrently to avoid health risks related to the central nervous system and the respiratory drive.
Prescribing Opioids for Minors
A written and approved consent must be obtained from parents or guardians of a minor before administering controlled substances as a treatment therapy. The consent, however, does not apply under extreme medical emergencies, and incidents of surgery.