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On March 15, 2016, the Centers for Disease Control and Prevention published its guidelines for
prescribing opioids for chronic pain to address the country’s prescription drug abuse epidemic.
Among the recommendations are that opioids should not be first-line therapy for chronic pain. The
recommendations states, “Nonpharmacologic therapy and nonopioid pharmacologic therapy are
preferred for chronic pain. Clinicians should consider opioid therapy only if expected benefits for
both pain and function are anticipated to outweigh risks to the patient.”
The recommendations also recommend a low starting dosage: “When opioids are started, clinicians
should prescribe the lowest effective dosage. Clinicians should use caution when prescribing opioids
at any dosage, should carefully reassess evidence of individual benefits and risks when considering
increasing dosage to =50 morphine milligram equivalents (MME)/day, and should avoid increasing
dosage to =90 MME/day or carefully justify a decision to titrate dosage to =90 MME/day.”
In a related development, the FDA has announced plans to add a boxed warning - its most serious
type - to all immediate-release opioid painkillers. The label will specify that the drugs should only
be used when other medications alternative therapies cannot control patients’ pain.