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Federal health officials have proposed a new set of opioid prescribing guidelines for chronic pain. The draft revisions no longer include specific dosage ceilings, among other changes that address controversial elements of the older guidance.

The changes would alter 2016 guidelines and are expected to be published this year following public comment. The authors continue to emphasize that opioids should not be seen as the first-line option to treat chronic pain conditions. But they now highlight the clinician’s role in determining the best pain control plan together with patients. 

The guidelines are not intended to be “inflexible standards of care across patient populations,” the authors stated in a proposed draft summary

Among the notable changes, according to medical news outlet Stat:

  • Removal of the language stating that prescribers should avoid increasing dosage to 90 morphine milligram equivalents or more per day. Now the authors advise that clinicians prescribe the “lowest dosage to achieve expected effects.” 
  • Suggested time limits for acute pain prescriptions have been removed. The original recommendations were three days or less, with the caveat that “more than seven days will rarely be needed.”

Rules vs. recommendations

The 2016 guidance often has been seen as rules rather than recommendations by federal and state policy makers attempting to help curb opioid dependency and overdoses. But patient advocates have argued that too-strict interpretations have led some doctors to unsafely taper doses or cut off patient access, Stat reported.

The new guidance is intended to support clinician-patient communication; improve safety and effectiveness; and reduce the risks tied to long-term opioid therapy, including opioid use disorder, overdose and death, the authors wrote.

The changes follow a review of the latest data as well as consultations with patient advocates and other stakeholders, according to the Centers for Disease Control and Prevention.

A summary of the draft guidance is posted in the Federal Register. The comment period closes March 11. See additional information in this HealthDay article.