CDC recommends loosening prescription restrictions on opioids

For the first time in six years, the CDC has updated its opioid guidance, providing clinicians with more leeway in treating Americans for pain, including tossing previous caps and limits on prescribing narcotics.

The new guidelines, which include 12 recommendations for patients 18 and older, come as Long Island and the rest of the nation battle an ongoing opioid epidemic that claimed the lives of a record 107,000 Americans in 2021.

A report released Tuesday by the Office of New York Comptroller Thomas DiNapoli found that overdose deaths statewide from opioids including fentanyl jumped by 68% from 2019 to 2021, taking nearly 5,000 lives. DiNapoli's report cited various causes for the surge in fatal drug overdoses, including social isolation and stress triggered by the pandemic, and substance abuse fueled by increases in mental illness over the past decade, especially among young adults.

The Centers for Disease Control and Prevention said its new guidelines are not meant to address illicit synthetic opioids, such as fentanyl.

Among the recommendations, which are voluntary for medical professionals, is the ending of hard dosage caps or strict limits on the length of treatment for individuals suffering with chronic pain. Caps and limits were a controversial component of the CDC's 2016 guidance, issued during the height of the epidemic.

That guidance was misapplied by insurers, clinicians and lawmakers, leaving patients with "untreated and under-treated pain, serious withdrawal symptoms, worsening pain outcomes, psychological distress, overdose, and [suicide]," the CDC wrote in its latest recommendations.

Federal officials Thursday said the new guidance provides a more balanced and measured approach in treating pain.

"It's intended to help improve communication between clinicians and patients," said Christopher Jones, acting director of the CDC’s National Center for Injury Prevention and Control, during a Thursday call with reporters. "Clinicians will be able to use this guideline to help patients set and achieve personal goals to reduce their pain and improve their function and quality of life. We know that people who live with pain experience many challenges. Having safe, consistent and effective pain treatment should not be one of them."

The new guidelines recommend clinicians consider nonopioid drugs, including anticonvulsants, antidepressants and steroids that are associated with moderate improvements in pain management. And when starting opioid treatment, doctors should use immediate-release opioids, rather than extended-release medication, the CDC said.

The recommendations do not apply to patients who are hospitalized or those suffering from sickle cell disease, cancer or in palliative or end-of-life care.

When opioids are prescribed to a patient for the first time, the CDC said, doctors should select the lowest effective dosage while using enhanced caution for patients on medication for long periods of time.

And doctors should have more frequent conversations with patients about opioid therapy, evaluating the risks and benefits within one to four weeks of starting treatment, officials wrote.

In a departure from the previous guidance, the CDC stressed that tapering or discontinuing opioids in patients who've taken them for an extended time can drive patients to purchase those drugs on the streets — creating a greater risk of overdose — if not provided with effective support.

"There were a lot of folks on opioids when this crisis hit and the crackdown began," said Jeffrey Reynolds, president and CEO of Garden City-based Family & Children’s Association, which provides substance abuse treatment for Long Islanders in recovery. " … A lot of folks were just summarily cut off from pain meds that they'd been on for a very long period of time. And they wound up out there on their own."

Nearly 800 Long Islanders Long Islanders died of opioid overdoses in 2021, Nassau and Suffolk officials said earlier this year. The deaths of more than 300 others, believed to be linked to opioids, have yet to be confirmed by the counties' respective medical examiners.

While the 2016 CDC guidance focused almost exclusively on primary care physicians, the latest recommendation expands the scope to dentists, post-op doctors and pain management specialists.

Dr. Yili Huang, founder of the Pain Management service at Northwell Health's Phelps Hospital in Sleepy Hollow, said the 2016 recommendations were interpreted as policy, rather than guidelines.

"That led to a lot of governmental groups and health care systems making very strict policies around how to take care of patients who are in pain," Huang said. "And that led to a lot of unclear, blanket statements that are not individualized. Chronic pain is not one-size-fits-all."

By Robert Brodsky

robert.brodsky@newsday.com@BrodskyRobert

Robert Brodsky is a breaking news reporter who has worked at Newsday since 2011. He is a Queens College and American University alum.