Public Comment on Opioid Prescription Guidelines Ends Today

The Centers for Disease Control and Prevention is still accepting comments on its draft guidelines for prescribing opioids for chronic pain, and 87 percent of doctors say they would welcome the guidelines, according to a new SERMO poll.

Out of 1,617 responses, the doctors responding were split 50-50 on whether Naloxone, a medication that can treat opioid overdoses, should be offered over the counter, though 81 percent thought there should be a public awareness campaign about the drug.

Still, 59 percent said they should be able to use opioids to treat chronic pain that isn’t caused by cancer or palliative care. Forty-one percent said opioids should only be used to treat pain caused by cancer or palliative care.

Of 1,961 doctors who were asked about the most important tactics to curbing opioid abuse, 43 percent said the broader use of prescription drug monitoring programs and making them interoperable across state lines would help. Another 20 percent said more education for physicians on prescribing practices was most important.

SERMO, a social media network for doctors, distributed the survey to a random group of users through email.

Those interested can submit comments on the draft guidelines through Wednesday. The proposed recommendations focus on three areas: Determining when to initiate or continue to prescribe opioids for chronic pain; opioid selection, dosage, duration, follow-up and discontinuation; and assessing the risks and harms of prescribing opioids.

Opting for nonpharmacologic and nonopioid pharmacologic therapies and prescribing immediate-release opioids rather than long-acting opioids are two of the more specific 12 recommendations put forth in the guidelines.

Doctors are also encouraged to start by prescribing the lowest effective dosage of the drug when first assigning the prescription, according to the draft guidelines. They should also evaluate patients within one to four weeks of first prescribing an opioid therapy, they say.

“Clinical guidelines represent one strategy for improving prescribing practices and health outcomes,” the CDC’s draft guidelines say. “In addition, policy initiatives that address barriers to implementation of the guidelines, such as accessibility of PDMP data, availability of providers of medication-assisted treatment for opioid use disorder, insurance coverage for nonpharmacologic treatments and appropriate urine drug testing, and reimbursable time for patient counseling might likewise be effective in enhancing implementation of the recommended practices.”

So far, the CDC has received more than 2,790 comments on the guidelines.

Massachusetts Attorney General Maura Healy wrote in a comment that the guidelines would provide much-needed information for primary care providers, and would standardize best practices that have been highlighted by states and other organizations.

“In particular, the Guideline makes clear that opioids should not be the initial treatment for chronic pain and should only be used where their benefits outweigh the risks,” she wrote. “Equally important, the Guideline advises prescribers to evaluate the benefit and harms of opioid treatment within weeks of the initial dose and re-evaluate the patient at least every three months.”

In another comment, the American Association of Nurse Anesthetists wrote that “the guideline should be inclusive of all prescribers across settings to optimize the impact on safe and appropriate use of opioids for chronic pain.”

Primary care providers should not manage a patient’s opioid treatment on their own for more than three months, the group also suggested.

“While the corresponding text does suggest that a primary care provider consult a pain specialist, this point is buried and could be easily missed by the provider who is responsible for developing a treatment plan,” the comment reads. “We therefore recommend that the seventh recommendation specifically state that the primary care provider seek specialty care within three months of initiating opioid therapy.”

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