The nation's top public health agency on Thursday proposed changing—and in some instances softening—guidelines for US doctors prescribing oxycodone and other opioid painkillers. The CDC's previous guidance, issued six years ago, helped slow the kind of prescribing that ignited the worst overdose epidemic in US history, the AP reports. But it also caused some doctors to become too quick to cut off patients taking prescription painkillers and too strict in keeping the drugs from patients who might benefit, CDC officials said. "We began to hear how the guidelines were being misused and misapplied," said the CDC's Christopher Jones, a co-author of the draft guidance.
The proposed changes, contained in a 229-page draft update in the Federal Register, would roll back some suggested limits on the drugs. Their publication opens a 60-day public comment period. The CDC will consider comments before finalizing the updated guidance. The general intent is to foster individualized patient care, Jones said. It also offers more options for treating the kind of short-term, acute pain that follows surgeries or injuries. When US overdose deaths began skyrocketing, prescription painkillers were identified as a big reason. Governments tried to restrict the prescriptions, but the overdose epidemic worsened as people hooked on pills switched to heroin and then to fentanyl. Those kinds of illegal injected drugs are now associated with the majority of US overdose deaths.
The CDC's 2016 prescribing guidelines said opioids should not be the first treatment for chronic pain. Doctors were urged to first try other medications or nondrug options, limit opioid prescriptions for short-term pain to three days, and prescribe the lowest effective dose possible. The guidelines are voluntary, but they were widely adopted and added momentum to a dramatic decline in opioid painkiller prescriptions. They also came under attack from pain patients and drug manufacturers, who argued some people in severe pain were being denied needed relief. Among the proposed changes:
- The CDC would no longer suggest trying to limit opioid treatment for acute pain to three days.
- The agency would drop the specific recommendation that doctors avoid increasing dosage to a level equivalent to 90 milligrams of morphine per day.
- For patients receiving higher doses of opioids, the CDC would urge doctors to not abruptly halt treatment unless there are indications of a life-threatening danger.
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