Total Health Law Blog
After the CDC issued its 2016 Opioid Prescribing Guideline, which focused on recommendations for primary care physicians, many physicians greatly limited prescribing opioids. This was in response to the opioid epidemic in our country which had an impact on reducing opioid abuse. However, it also may have left patients undertreated for pain given the 2016 guideline’s emphasis on not prescribing opioids. In November 2022, the CDC issued updated guidance for a broader group of clinicians. This blog series provides an overview of the more-than-60-page CDC guidance. This first blog will provide an overview of what the guidance is intended to accomplish and how it is presented. Our attorneys are experienced in advising healthcare businesses and pain management practices. If you have pain management prescribing questions or would like to discuss this blog post, you may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@hamillittle.com. You may also learn more about our law firm by visiting www.hamillittle.com.
First, the updated guidance “is intended for clinicians who are treating outpatients aged ≥18 years with acute (duration of <1 month), subacute (duration of 1–3 months), or chronic (duration of >3 months) pain, and excludes pain management related to sickle cell disease, cancer-related pain treatment, palliative care, and end-of-life care.” As specified, “[t]he recommendations are most relevant to clinicians whose scope of practice includes prescribing opioids (e.g., physicians, nurse practitioners and other advanced-practice registered nurses, physician assistants, and oral health practitioners).”
Second, “the recommendations address the use of opioid pain medication in certain special populations (e.g., older adults and pregnant persons) and in populations with conditions posing special risks (e.g., a history of a substance use disorder).” Importantly, they “do not address the use of opioid pain medication in children or adolescents aged <18 years.”
Third, the guidelines include 12 recommendations for the clinicians and patients mentioned above. The recommendations are grouped into four areas:
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Determining whether or not to initiate opioids for pain
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Selecting opioids and determining dosages
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Deciding duration of initial opioid prescription and conducting follow-up
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Assessing risk and addressing potential harms of opioid use
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Fourth, “[t]he recommendations are not intended to be implemented as absolute limits of policy or practice across populations by organizations, health care systems, or government entities.”
Fifth, the recommendations are governed broadly by five guiding principles:
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Acute, subacute, and chronic pain needs to be appropriately assessed and treated independent of whether opioids are part of a treatment regimen.
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Recommendations are voluntary and are intended to support, not supplant, individualized, person-centered care. Flexibility to meet the care needs and the clinical circumstances of a specific patient is paramount.
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A multimodal and multidisciplinary approach to pain management attending to the physical health, behavioral health, long-term services and supports, and expected health outcomes and well-being of each person is critical.
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Special attention should be given to avoid misapplying this clinical practice guideline beyond its intended use or implementing policies purportedly derived from it that might lead to unintended and potentially harmful consequences for patients.
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Clinicians, practices, health systems, and payers should vigilantly attend to health inequities; provide culturally and linguistically appropriate communication (117), including communication that is accessible to persons with disabilities; and ensure access to an appropriate, affordable, diversified, coordinated, and effective nonpharmacologic and pharmacologic pain management regimen for all persons.
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Our attorneys are experienced in advising healthcare businesses and pain management practices. If you have pain management prescribing questions or would like to discuss this blog post, you may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, info@hamillittle.com. You may also learn more about our law firm by visiting www.hamillittle.com.
*Disclaimer: Thoughts shared here do not constitute legal advice.