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What the CDC’s New Opioid Guidelines Mean for Your Pain Management

Experts say the updated recommendations reflect the need for individualized, compassionate care.
What the CDCs New Opioid Guidelines Mean for Your Pain Management
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Opioids are a powerful, pain-relieving class of drugs—but they’re controversial for a reason. Historically, “street opioids” like heroin have been largely responsible for mounting opioid overdose deaths, but recent data show that prescription opioids, like oxycodone and hydrocodone, also play a role in this crisis, according to the Centers for Disease Control and Prevention (CDC). That’s a big reason why the agency’s influential prescribing guidelines for these painkillers were rather strict. Those recommendations, originally released in 2016, were just updated to better reflect the need for individualized, compassionate care.

The CDC issued new opioid prescribing guidelines for health care providers in early November; specifically, the recommendations detail when opioids should be considered for “appropriate pain treatment, with careful consideration of the benefits and risks.”

The agency’s 2016 guidelines, a well-intentioned step in combatting the opioid epidemic, were criticized by many experts. Doctors, insurance companies, and pharmacies sometimes didn’t interpret the previous guidelines correctly. As an “unintended effect,” many people suffered from “untreated and undertreated pain, serious withdrawal symptoms, worsening pain outcomes, psychological distress, overdose, and suicide ideation and behavior,” the CDC notes.

Misinterpretations of the 2016 guidelines “often created a barrier for people who could have benefitted from opioid medications,” Jamie Alan, PharmD, PhD, associate professor of pharmacology and toxicology at Michigan State University, tells SELF. Though “the rationale for stricter guidelines was clear,” she says, it also “created a culture of fear, where physicians were afraid to consider and/or prescribe opioids for patients.”

O. Trent Hall, DO, an addiction medicine physician at The Ohio State University Wexner Medical Center, agrees. He tells SELF that the previous guidelines were “widely misunderstood and misapplied,” noting that government regulators and insurance companies were “desperate to turn the tide in the opioid overdose crisis.” The hope, he explains, was that by cutting back on opioid prescriptions, the number of deaths from accidental overdoses would drop. Unfortunately, largely due to the introduction of illicitly manufactured fentanyl, a potent synthetic opioid, accidental drug overdose deaths increased from 63,000 in 2016 to 108,000 in 2021, Dr. Hall says.

The new prescribing guidelines open doors for more personalized pain management.

The CDC’s new recommendations will be widely considered by health care providers—but they’re not set in stone policies, laws, or, as the CDC puts it, “inflexible standards of care.”

To be clear, opioids should not be a first-line treatment for pain in many cases—but the updated guidance will, hopefully, pave the path toward individualized treatment and better quality of care for people who have exhausted other pain relief options. Specifically, the guidance “emphasizes the importance of person-centered care, and the provider and patient developing a plan that adequately addresses pain,” Sarah Cercone Heavey, PhD, MPH, a clinical assistant professor at the University at Buffalo’s School of Public Health and Health Professions, tells SELF.

When appropriate, the CDC says opioids may be prescribed at the lowest effective dosage as needed; the new guidelines no longer specify prescription dosage or duration limits but still warn against prescribing above a threshold in which the risks may outweigh the benefits—basically, it’s up to health care providers to map out what’s best for their patients.

The CDC also addresses what Dr. Heavey calls “aggressive opioid tapering”—a method that quickly weans someone off of opioids, spiking the risk for withdrawal—and recommends against it outside of severe circumstances. “Many patients were discontinued from opioids, often abruptly with no taper or a taper that was too short in time or too aggressive in dose,” Dr. Heavey explains. “These updated guidelines recommend a much softer discontinuation in consultation with the patient’s experience.”

When should opioids be considered for pain management?

The CDC says its new recommendations “do not apply to pain related to sickle cell disease or cancer or to patients receiving palliative or end-of-life care.” Dr. Nelson notes there are some circumstances in which prescribing opioids is warranted. “If you have a terrible fracture, you shouldn’t be sitting there in [severe] pain,” he explains. Pain is “difficult to measure objectively,” he adds, but “that’s the job of the clinician to figure out.”

In general, “opioids may be considered for patients with pain from injuries, or who have pain after surgery,” Dr. Hall says. The new guidelines stress that opioids should not be used as a first-line treatment for the following situations:

  • low back pain
  • neck pain
  • musculoskeletal injury pain (sprains, strains, tendonitis, and bursitis)
  • pain related to minor surgeries (like dental surgery)
  • dental pain
  • kidney stone pain
  • headaches, including episodic migraine

Other pain-relieving medications, such as non-steroidal anti-inflammatory drugs (NSAIDs like ibuprofen) should still be used before opioids when it makes sense, Dr. Heavey says. “We know that non-opioid therapies like NSAIDs are at least as effective as opioids for many kinds of acute pain,” she explains. “Importantly, NSAIDs lack the risk profile of opioids, including the risk for addiction.” Unmedicated options for pain relief—like rest, hot or cold therapy, and physical therapy—should also be talked about, Dr. Heavey says.

All that said: The changes in these guidelines are just the first step. As NPR reported, reversing the damage that was done by the 2016 guidelines won’t happen overnight—and true change for people experiencing and living with pain will also hinge on whether other major agencies, like the Drug Enforcement Administration and the Centers for Medicare and Medicaid Services, follow a similar roadmap. 

Overall, though, many experts believe we’re heading in the right direction. “I am very grateful,” Dr. Alan says. “The updated guidelines are a great step to come to a middle ground where we protect patients from the potential harm of opioids while still allowing opioid use when appropriate.”

If you are struggling and need someone to talk to, you can get support by calling the National Suicide Prevention Lifeline at 988 or by texting HOME to 741-741, the Crisis Text Line. If you’re outside the United States, here is a list of international suicide helplines.