CDC Guideline for Prescribing Opioids for Chronic Pain
In 2016, the Centers for Disease Control and Prevention (CDC) developed and published the evidence-based CDC Guideline for Prescribing Opioids for Chronic Pain to provide recommendations for the prescribing of opioid pain medication for patients 18 and older in primary care settings. Recommendations focus on the use of opioids in treating chronic pain (pain lasting longer than three months or past the time of normal tissue healing) outside of active cancer treatment, palliative care and end-of-life care.
“Improving the way opioids are prescribed through clinical practice guidelines can ensure patients have access to safer, more effective chronic pain treatment while reducing the number of people who misuse, abuse, or overdose from these drugs.”
— CDC Guideline for Prescribing Opioids for Chronic Pain
Provider and IT-based organizations have incorporated the 12 evidence-based CDC recommended guidelines into provider-based workflows as a strong foundation for improvement. As is discussed in the next section (EHRA Opioid CDC CDS Implementation Guide), the 12 guidelines can be incorporated as EHR-based pathways and clinical decision support interventions.
The CDC Guideline addresses patient-centered clinical practices including conducting thorough assessments, considering all possible treatments, closely monitoring risks, and safely discontinuing opioids. The three focus areas in the guideline include:
- Determining when to initiate or continue opioids for chronic pain
- Selection of non-pharmacologic therapy, nonopioid pharmacologic therapy, opioid therapy
- Establishment of treatment goals
- Discussion of risks and benefits of therapy with patients
- Opioid selection, dosage, duration, follow-up, and discontinuation
- Selection of immediate-release or extended-release and long-acting opioids
- Dosage considerations
- Duration of treatment
- Considerations for follow-up and discontinuation of opioid therapy
- Assessing risk and addressing harms of opioid use
- Evaluation of risk factors for opioid-related harms and ways to mitigate patient risk
- Review of prescription drug monitoring program (PDMP) data
- Use of urine drug testing
- Considerations for co-prescribing benzodiazepines
- Arrangement of treatment for opioid use disorder
HIMSS EHRA (Electronic Health Record Association) Opioid CDC CDS Implementation Guide
The HIMSS Electronic Health Record Association (EHRA) is an association of Electronic Health Record (EHR) companies, addressing national efforts to create interoperable EHRs in hospital and ambulatory care settings. The EHR Association operates on the premise that rapid, widespread adoption of EHRs will help improve the quality of patient care as well as the productivity and sustainability of the healthcare system.
In 2018, the EHRA vendor community formed an opioid task force to research and provide recommendations on how EHR technology can address the opioid crisis. The clinical practice guideline subgroup worked on identifying a set of clinical practice guidelines that can be operationalized to improve opioid stewardship in clinical practice. The group decided to utilize the CDC Guideline for Prescribing Opioids for Chronic Pain. The result is the EHRA Opioid CDC Clinical Decision Support (CDS) Implementation Guide.
In the EHRA implementation guide, there is a section for each of the 12 CDC recommendations for prescribing opioids for chronic pain (outside of active cancer, palliative, and end-of-life care). For each recommendation, details are provided on what EHR’s offer to address each item as well as guidance on how a healthcare organization can implement. While there may be some differences across EHR vendors as to how each recommendation is operationalized, the functionality and recommendations are generally available and in common across vendors.