The CDCs latest opioid prescribing guidelines, released this March, were created with the goal of achieving balance between the analgesic and addictive properties of opioid analgesics, to uphold the safety as well as meet the pain management needs of the public at large. Unfortunately, the controversy surrounding these guidelines points to a detrimental issue at the crux of their implementation: A fractured field – two expert, yet conflicting, schools of thought on the current opioid policy.

  • Treating chronic pain with a wider range of treatments, as opposed to relying mainly on opioid regimens.
  • Avoiding the use of high dose prescriptions, as well as the combined prescription of opioids and benzodiazepines, to reduce the risk of overdose.
  • Providing addiction treatment when necessary (methadone, buprenorphine).

There are two conflicting schools of thought regarding treatment approaches to opioids…

  1. Reduce Pain and Suffering.
    This paradigm stems from an aggressive movement in the 1990s wherein physicians trained in pain management and palliative care were instructed to be sympathetic to pain. Enforced by the belief that those in true pain would not become addicted and reinforced by pharmaceutical companies and federal agencies pointing to pain as “the fifth vital sign,” this movement missed the boat on understanding the serious risks of opioid addiction.
  2. Prevent and Treat Addiction.
    Driven by addiction specialists, who lacked an understanding of the seriousness of debilitating and chronic pain and whose priorities were vastly different than pain and palliative care physicians, practitioners of this model had a more thorough understanding of the addictive risks of opioid regimens. They watched the sales of opioid prescriptions quadruple from 1999-2010 – alongside the rate of overdose deaths. Though the need for a rapid public health response remained apparent, insufficient evidence on safe stoppage procedures for opioid regimens existed. Dissention among experts as to the seriousness of the problem and how to address also further muddied the waters.

The Fulcrum between Analgesia and Addiction

Though the CDC’s recently released guidelines are as strong as they can currently be, opioid pain treatment regimens – and addiction treatments – continue to be a work in progress. The fractured nature of this field reflects the reason changes were such a long time coming. A multidisciplinary approach will be as essential to working out the kinks as they were to the development of the CDC’s recently released guidelines, as all parties involved strive to save lives and ensure quality of care.

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