With this weekly column, Elite Healthcare provides readers with insight related to the legal implications of healthcare – offering practical guidance on scenarios that should be avoidable and providing suggested courses of action when appropriate. The examples provided here are those that all providers should be aware of, but many aren’t or are negligent despite their awareness. Don’t let your practice be compromised.
Following Guidelines for Chronic Pain Medication
This summer, officials with the Centers for Disease Control and Prevention (CDC) released an official advisement alerting healthcare providers and the public about what had been determined to be a “misapplication” of previously announced CDC guidelines regarding the prescribing of opioids for chronic pain. Written in 2016, the guidelines provide recommendations for primary care clinicians who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care.1
The guidelines address when to initiate or continue opioids for chronic pain; opioid selection, dosage, duration, follow-up, and discontinuation; and assessing risk and addressing harms of opioid use. Developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework,2 CDC recommendations are made on the basis of a systematic review of the scientific evidence while considering benefits and harms, values and preferences, and resource allocation. In making the recommendations, the CDC obtained input from experts, stakeholders, the public, peer reviewers, and a federally chartered advisory committee. “It is important that patients receive appropriate pain treatment with careful consideration of the benefits and risks of treatment options,” CDC officials wrote at the time, and the guidelines are intended to improve communication between clinicians and patients about the risks and benefits of opioid therapy for chronic pain, to improve the safety and effectiveness of pain treatment, and to reduce the risks associated with long-term opioid therapy, including opioid use disorder, overdose, and death.
In part, the guidelines also state: “When opioids are started, clinicians should prescribe the lowest effective dosage. Clinicians should avoid increasing dosage to 90 or more morphine equivalent units per day. The recommendation statement does not suggest discontinuation of opioids already prescribed at higher dosages. The guideline does not support abrupt tapering or sudden discontinuation of opioids.” Any healthcare provider who has not yet become very familiar with the contents of the guidelines, they should do so. The CDC also provides a checklist to refer to when prescribing opioids for chronic pain.3
- Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic
pain — United States, 2016. CDC. 2016. Accessed online:
- What is GRADE? 2019. Accessed online: www.gradeworkinggroup.org
- Checklist for prescribing opioids for chronic pain. CDC. 2016. Accessed online:
Joe Darrah is a freelance author based in the Philadelphia region who has been
covering the healthcare field since 2004. He may be reached at [email protected]
Lawrence F. Kobak is senior counsel in the healthcare department at Frier Levitt, a
national boutique healthcare law firm based in Uniondale, NY, that provides
comprehensive regulatory, transactional, and litigation counsel to the healthcare and
life sciences industries. He may be reached at [email protected]