Opioids for Pain Clinical Practice Guidelines (CDC, 2022)

US Centers for Disease Control and Prevention

These are some of the highlights of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

December 08, 2022

Guidelines for prescribing opioids for adults with acute and chronic pain were published in November 2022 by the US Centers for Disease Control and Prevention (CDC) in the Morbidity and Mortality Weekly Report (MMWR).[1,2]

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.


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