Registrar’s message – new CDC opioid guidelines a game-changer

As the Centers for Disease Control and Prevention (CDC) points out, there were more than 28,947 opioid-related deaths in the US in 2014, which is a 14 per cent climb from the year before. British Columbians are not immune from this epidemic. Prescription drug abuse kills as many here in this province as drinking and driving.

Seeing those numbers – even with the knowledge that many of those deaths were from drugs purchased off the street – it is clear that physicians play a critical role in managing this serious problem.

The 12 recommendations from the CDC are well-researched, well-reasoned and clear. They address how primary care physicians can determine when to initiate or continue opioids for chronic pain; how they might select opioids; the dosage, duration, follow-up and discontinuation; and the assessment of risk and addressing harm.

Much of what is contained in the CDC guideline is outlined in the College’s own Prescription Review Panel Prescribing Principles for Chronic Non-Cancer Pain. Specifically, the CDC encourages physicians to avoid prescribing opioid pain medication and benzodiazepines concurrently; to monitor patients routinely through urine drug testing; and to prescribe the lowest effective dosage when opioids are started, among other parallel recommendations.

The CDC further recommends that physicians review a patient’s history using state prescription drug monitoring program data, which in BC would be equivalent to PharmaNet. This underlines the College’s position that physicians should be checking PharmaNet each time a patient is prescribed medications. British Columbia is fortunate to be one of the few provinces in Canada where physicians have access to such a database for the benefit of their patients.

At its recent meeting, the Board endorsed the CDC guideline and directed that the College review and update its prescribing principles to reflect the 12 recommendations contained in the document. In the interim, registrants are strongly encouraged to review the CDC guideline and apply the recommendations in their practice.

The CDC Guideline for Prescribing Opioids for Chronic Pain – United States 2016 can be found here. Additional tools to guide physicians who wish to implement the recommendations can be found here.

Heidi M. Oetter, MD

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