Opioid Abuse Guidelines

Updated: Sep 05, 2023
  • Author: David W Dixon, DO; Chief Editor: Glen L Xiong, MD  more...
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Guidelines Summary

US Centers for Disease Control and Prevention

In November 2022, the US Centers for Disease Control and Prevention (CDC) release updated recommendations for prescribing opioids for adults with acute and chronic pain not related to cancer, sickle cell disease, or palliative/end-of-life care. [77, 78] Guidelines address the following:

Initiating opioids for pain

Before initiating opioid therapy, clinicians should discuss with patients the realistic benefits and known risks of opioid therapy.

Clinicians should maximize use of nondrug and nonopioid drug therapies, as these are at least as effective as opioids for many common types of acute pain and are preferred for subacute and chronic pain.

Selecting opioids for pain

When initiating opioid therapy for acute, subacute, or chronic pain, clinicians should prescribe immediate-release opioids instead of extended-release and long-acting (ER/LA) opioids.

Clinicians should prescribe the lowest effective dosage when opioids are initiated for opioid-naïve patients with acute, subacute, or chronic pain. 

Deciding duration of opioid prescription

When opioids are needed for acute pain, clinicians should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids.

Clinicians should evaluate benefits and risks with patients within 1–4 weeks of starting opioid therapy for subacute or chronic pain or of dosage escalation.

Assessing risk of opioid abuse

Clinicians should evaluate risk for opioid-related harms and discuss risk with patients before starting and periodically during continuation of opioid therapy.

When prescribing initial opioid therapy for pain, clinicians should review the patient’s history of controlled substance prescriptions to determine whether the patient is receiving opioid dosages or combinations that put the patient at high risk for overdose.

For patients with opioid use disorder, clinicians should offer or arrange treatment with evidence-based medications.

Substance Abuse and Mental Health Services Administration

In March 2020, the Substance Abuse and Mental Health Services Administration (SAMHSA) released considerations for the care and treatment of mental and substance use disorders in the COVID-19 pandemic. [79, 80, 81]

SAMHSA advises that outpatient treatment options be used to the greatest extent possible. Inpatient facilities should be reserved for those for whom outpatient measures are not considered an adequate clinical option. SAMHSA strongly recommends the use of telehealth and/or telephonic services to provide evaluation and treatment of patients.

States may request blanket exceptions for all stable patients in an opioid treatment program (OTP) to receive 28 days of Take-Home doses of the patient’s medication for opioid use disorder (OUD). States may request up to 14 days of Take-Home medication for those patients who are less stable but who the OTP believes can safely handle this level of Take-Home medication.

American Society of Addiction Medicine

In response to the COVID-19 pandemic, the American Society of Addiction Medicine (ASAM) released a focused update to its National Practice Guideline for the Treatment of Opioid Use Disorder (NPG). [82]  New recommendations include the following:

  • Comprehensive assessment of a patient is critical for treatment planning, but completing all assessments should not delay or preclude initiating pharmacotherapy for opioid use disorder (OUD)

  • If patients can't access psychosocial treatment because they are in isolation or have other risk factors that preclude external interactions, clinicians should not delay initiation of medication for the treatment of addiction

  • Home-based buprenorphine induction is safe and effective for treatment of OUD