must be satisfied that the prescription is consistent with CSA and DEA regulations before dispensing the controlled substance to the ultimate user (DEA, 2018c). Healthcare Consideration: The number of drug overdose deaths increased by nearly 5% from 2018 to 2019 and has quadrupled since 1999. Over 70% of the 70,630 deaths in 2019 involved an opioid (CDC, 2021). Therefore, competence with both state and federal regulations should be maintained. CDC CLINICAL PRACTICE GUIDELINES FOR PRESCRIBING OPIOIDS FOR PAIN
stone pain, acute episodic migraine), and postoperative pain, and pain related to oral surgery procedures (Dowell et al., 2022). Healthcare Consideration: State boards of nursing are an excellent source of information for NPs on how state laws and regulations impact practice. NPs and other prescribers must know all the details about advanced practice in their state— from signature authority to the number of CE hours required for licensure.
This clinical practice guideline 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 (Dowell et al., 2022). This clinical practice guideline is intended to assist clinicians in weighing the benefits and risks of prescribing opioid pain medication for painful acute conditions (e.g., low back pain, neck pain, other musculoskeletal pain, neuropathic pain, dental pain, kidney
CDC Clinical Practice Guidelines for Prescribing Opioids for Pain
Recommendation 1: Nonopioid therapies are at least as effective as opioids for many common types of acute pain. Clinicians should maximize nonpharmacologic and nonopioid pharmacologic therapies as appropriate for the specific condition and patient and only consider opioid therapy for acute pain if benefits are anticipated to outweigh risks to the patient. Before prescribing opioid therapy for acute pain, clinicians should discuss with patients the realistic benefits and known risks of opioid therapy. Recommendation 2: Nonopioid therapies are preferred for subacute and chronic pain. Clinicians should maximize the use of nonpharmacologic and nonopioid pharmacologic therapies as appropriate for the specific condition and patient and only consider initiating opioid therapy if the expected benefits for pain and function are anticipated to outweigh risks to the patient. Before starting opioid therapy for subacute or chronic pain, clinicians should discuss with patients the realistic benefits and known risks of opioid therapy, should work with patients to establish treatment goals for pain and function, and should consider how opioid therapy will be discontinued if benefits do not outweigh risks. Recommendation 3: When starting opioid therapy for acute, subacute, or chronic pain, clinicians should prescribe immediate-release opioids instead of extended-release and long-acting (ER/LA) opioids. Recommendation 4: When opioids are initiated for opioid-naïve patients with acute, subacute, or chronic pain, clinicians should prescribe the lowest effective dosage. If opioids are continued for subacute or chronic pain, clinicians should use caution when prescribing opioids at any dosage, should carefully evaluate individual benefits and risks when considering increasing dosage, and should avoid increasing dosage above levels likely to yield diminishing returns in benefits relative to risks to patients. Recommendation 5: For patients already receiving opioid therapy, clinicians should carefully weigh benefits and risks and exercise care when changing opioid dosage. If the benefits outweigh the risks of continued opioid therapy, clinicians should work closely with patients to optimize nonopioid therapies while continuing opioid therapy. If the benefits do not outweigh the risks of continued opioid therapy, clinicians should optimize other therapies and work closely with patients to gradually taper to lower dosages or, if warranted based on the individual circumstances of the patient, appropriately taper and discontinue opioids. Unless there are indications of a life-threatening issue, such as warning signs of impending overdose (e.g., confusion, sedation, or slurred speech), opioid therapy should not be discontinued abruptly, and clinicians should not rapidly reduce opioid dosages from higher dosages. Recommendation 6: When opioids are needed for acute pain, clinicians should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. Recommendation 7: Clinicians should evaluate benefits and risks with patients within 1–4 weeks of starting opioid therapy for subacute or chronic pain or dosage escalation. Clinicians should regularly reevaluate the benefits and risks of continued opioid therapy with patients.
Determining whether or not to initiate opioids for pain
Selecting opioids and determining dosages
Deciding the duration of initial opioid prescriptions and conducting follow-up
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