CDC Issues Updated Recommendations on Prescribing Opioids for Pain

November 10, 2022

The Centers for Disease Control and Prevention (CDC) updated its recommendations for clinicians providing pain care for adult outpatients with short- and long-term pain and removed dose limits that have led to forced tapering for patients with chronic pain.  

These updated clinical recommendations, published in the CDC Clinical Practice Guideline for Prescribing Opioids for Pain will assist clinicians in working with their patients to ensure the safest and most effective pain care is provided. The publication updates and replaces the guideline released by the CDC in 2016.  

The 2022 Clinical Practice Guideline addresses the following areas: 1) determining whether to initiate opioids for pain, 2) selecting opioids and determining opioid dosages, 3) deciding duration of initial opioid prescription and conducting follow-up, and 4) assessing risk and addressing potential harms of opioid use.   

Some modifications to the guideline were made, 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 physicians 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 physicians to not abruptly halt treatment unless there are indications of a life-threatening danger. The CDC offers suggestions on tapering patients off the drugs. It includes advice on ways physicians and patients can discuss tapering off drugs; a warning that clinicians should “weigh benefits and risks and exercise care when changing opioid dosage;” and a notice that they should “regularly reevaluate benefits and risks of continued opioid therapy with patients.” 

• The guideline recommends that clinicians try non-opioid approaches to pain control before initiating the medication. 

• The guideline notes disparity in the care of people of color, some of whom are less likely to be referred to a pain specialist or receive postpartum pain assessments than White people.  

“These updated guidelines will ensure that patients with chronic pain will continue to receive the medications needed to allow them to function,” said MMA President Will Nicholson, MD. “The previous version of these guidelines was misused by some payers and pharmacies to establish hard practice standards that forced patients with chronic pain to taper their medications, even if tapering was not in their best interest.”   

The new recommendations are voluntary and provide flexibility to clinicians and patients to support individualized, patient-centered care. They should not be used as an inflexible, one-size-fits-all policy or law; applied as a rigid standard of care; or replace clinical judgement about personalized treatment. 

The CDC followed a rigorous scientific process using the best available evidence and expert consultation to develop the 2022 Clinical Practice Guideline. An independent federal advisory committee, four peer reviewers, and members of the public reviewed the draft updated guideline, and CDC revised it in response to this feedback to foster a collaborative and transparent process. The CDC also engaged with patients with pain, caregivers, and clinicians to gain insights and gather feedback from people directly impacted by the guideline. The expanded guideline aims to ensure equitable access to effective, informed, individualized, and safe pain care. 

Additional materials associated with the guideline are available for patients and clinicians (which includes information on what is new in the guideline, and what has changed.)