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CDC issues a revamp of opiod guidelines, giving clinicians more leeway

MARY LOUISE KELLY, HOST:

Many doctors in the U.S. are uneasy when it comes to prescribing opioids, considering the risks of addiction and overdose. But opioids are necessary to treat some kinds of pain. And today the Centers for Disease Control and Prevention came out with new guidelines on when and how the drug should be prescribed. NPR health reporter Will Stone has been studying these new guidelines. Hey there, Will.

WILL STONE, BYLINE: Hi, Mary Louise.

KELLY: Before we get into the details of what they are, what they say, why did the CDC put them out today?

STONE: Yeah. Well, pain remains a big problem. Estimates are about 1 in 5 people in the U.S. experience chronic pain. And the evidence on pain has evolved since the last guidelines came out in 2016. But these new guidelines are also CDC's effort to correct course because of what happened after those previous guidelines. Opioid prescribing in the U.S. was already on the decline, and the CDC's 2016 recommendations really accelerated that.

Doctors went from overprescribing to the opposite end of the spectrum, where many became reluctant to give any opioids at all. And this led to another crisis of untreated pain. It affected all kinds of patients, those with injuries or coming out of surgery with acute pain. It affected patients with chronic pain who suddenly had their prescriptions cut down or stopped altogether. This had some horrible unintended consequences. Some patients even turned to the illegal drug market. Some died by suicide.

KELLY: Did the CDC acknowledge any of that in these new guidelines?

STONE: They did. For years, I mean, doctors and the CDC have said the guidelines were being misread and misapplied. And they were supposed to be voluntary, not rules that were applied to all pain patients. And the new recommendations are trying to make that clear and strike a balance. I spoke to Dr. Samer Narouze about this. He's the head of the American Society of Regional Anesthesia and Pain Medicine.

SAMER NAROUZE: You can tell the culture behind the 2016 guidelines is just cut down opioids. And the opposite, when you look at this one, you can sense that they are caring now more about patients living in pain, their experience more than just your goals to cut, cut, cut, cut down on opioids.

STONE: Now, just to be clear, doctors like Narouze say opioids should not be the go-to option when treating pain. There are many other things we should try first. But for some patients, opioids do make sense. And doctors need to have flexibility.

KELLY: Right. And I want to follow up on what Narouze was saying there, that this is about the patient. So these are new rules for doctors, of course. But what does this practically mean for people who may need these drugs?

STONE: Yeah, that is still an open question. Hopefully, doctors pay attention to these guidelines. But some patients have been waiting a long time for them, and they still don't feel reassured. One of them is Cindy Steinberg. She's with the U.S. Pain Foundation, which is a patient advocacy group.

CINDY STEINBERG: Most people that I know - and I know a lot of people living with chronic pain - have already been taken off their medication. Doctors are incredibly fearful of prescribing at all. So I don't think this is going to make a major difference.

STONE: Now, the broader issue here is that the older guidelines influenced other opioid restrictions. There were new state laws, rules by insurers and state medical boards. The CDC says that wasn't supposed to happen, and they're now repeatedly emphasizing this in their updated guidelines. But we don't know yet if that will translate into new policies that make doctors more comfortable prescribing.

KELLY: NPR's Will Stone. Thank you.

STONE: Thank you. Transcript provided by NPR, Copyright NPR.

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