Press Release (Hat tip: Dr. Menadue):
The Iowa Board of Medicine is encouraging physicians to consider a new federal guideline aimed to reduce the risk of addiction when treating chronic pain patients with controlled substances.
The Board recently adopted a new administrative rule to update a list of recommended resources for physicians who treat chronic pain. The list now includes the new Centers for Disease Control and Prevention Guideline for Prescribing Opioids for Chronic Pain.
CDC developed and published the guideline in March 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 3 months or past the time of normal tissue healing) outside of active cancer treatment, palliative care, and end-of-life care.
The CDC said that 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.
Clinical practices addressed in the CDC guideline include:
- Determining when to initiate or continue opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care
- Opioid selection, dosage, duration, follow-up, and discontinuation
- Assessing risk and addressing harms of opioid use
The CDC has produced three brochures (attached) to highlight the message in the non-binding standards:
- Pocketguide summary of the CDC guideline
- A checklist for providers who prescribes opioids for chronic pain
- Non-opioid treatments for chronic pain
In the latter brochure, the CDC emphasizes that opioids are not the first-line therapy for chronic pain outside of active cancer treatment, palliative care, and end-of-life care. Evidence suggests that nonopioid treatments, including nonopioid medications and nonpharmacological therapies, can provide relief to those suffering from chronic pain, and are safer.
The federal guideline complements the Iowa Board’s administrative rule on appropriate pain management. This rule, 653 IAC 13.2, reinforces that physicians should not fear board action for treating pain with controlled substances as long as the physicians’ prescribing is consistent with appropriate pain management practices.
The Board’s rule encourages physicians to closely monitor patients who are prescribed opioids, including reviewing their controlled substance prescription history, considering the use of pain management agreements, and considering utilizing drug testing to ensure that the patient is receiving appropriate therapeutic levels of prescribed medications.
The Board strongly recommends that physicians consult the following resources regarding the proper treatment of chronic pain:
- American Academy of Hospice and Palliative Medicine
- American Academy of Pain Medicine
- American Pain Society
- DEA Policy Statement: Dispensing Controlled Substances for the Treatment of Pain.
- Interagency Guideline on Prescribing Opioids for Pain (Developed by the Washington State Agency Medical Directors’ Group)
- Responsible Opioid Prescribing: A Physician’s Guide. (By Scott Fishman, M.D.)
- World Health Organization: Pain Relief Ladder. Cancer pain relief and palliative care. Technical report series 804
- CDC Guideline for Prescribing Opioids for Chronic Pain
For the past five years, the Board has required primary care physicians to complete training on chronic pain management as a part o
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