Recently, the U.S. Centers for Disease Control and Prevention (CDC) released new, non-binding recommendations for healthcare practitioners who prescribe opioid drugs for their patients with chronic pain. The CDC hopes that the new recommendations, called the CDC Guideline for Prescribing Opioids for Chronic Pain, United States, 2016, will help primary care health practitioners provide both effective and safe treatment for their patients.
Opioids (also known as opiates or commonly called "narcotics") are a class of drugs that include the illegal drug heroin as well as prescription painkillers such as morphine, codeine, oxycodone and hydrocodone. The prescription drugs are effective at treating pain and are generally safe when taken as directed by a healthcare practitioner for a short time. However, they can lead to dependence if used for longer periods of time for chronic pain, even when taken as prescribed, and can lead to fatal overdoses if misused.
The CDC released the recommendations in response to the dramatic rise in prescription opioid overdoses in the last few years. "More than 40 Americans die each day from prescription opioid overdoses, we must act now," said CDC Director Tom Frieden, M.D., M.P.H, in a statement. "Overprescribing opioids—largely for chronic pain—is a key driver of America's drug-overdose epidemic," said Dr. Frieden. "The guideline will give physicians and patients the information they need to make more informed decisions about treatment."
One of the 12 recommendations in the new guidelines is for primary care health practitioners to ask patients to take a urine drug test before prescribing opioids, as well as to consider urine testing at least once a year if patients remain on opioid drugs. One goal of the urine test is to determine whether patients are taking other prescription drugs or illegal drugs that might increase their risk of an overdose.
"Urine drug tests can provide information about drug use that is not reported by the patient," according to the CDC, and can also alert healthcare practitioners that patients may not be taking opioids as prescribed.
Before testing, healthcare practitioners should explain to patients that urine drug testing is aimed at improving safety. They should have an open and honest conversation about use of prescribed medications and other drugs, and whether the test might show unexpected results. "This will [give] patients an opportunity to provide information about changes in their use of prescribed opioids or other drugs," say to the guidelines. Healthcare practitioners should also understand and explain to patients what the urine drug tests can show, including presence and absence of prescribed drugs and/or illicit drugs.
Typically, urine drug testing involves an initial panel of screening tests that can detect different classes of drugs. Positive results may be followed by confirmatory tests that identify the specific drug(s) present. If a drug the patient is taking is not included in the panel, it may be tested for separately. (For details, see the article on Drug Abuse Testing.) While urine drug testing can show whether or not a person took a particular drug, it cannot show how much or what dose that person took.
Healthcare practitioners should discuss unexpected results with pathologists, scientists or toxicologists at the testing laboratory and with the patient. "Discussion with patients prior to specific confirmatory testing can sometimes yield a candid explanation of why a particular substance is present or absent," state to the guidelines.
The CDC wants patients to view the new guidelines as an opportunity and understand that drug test results can be used to improve patient safety. After talking with their healthcare practitioners, patients may, for example, switch to non-opioid pain relievers or to therapy that does not include drugs, plan more frequent evaluations by the healthcare practitioner, or be referred for substance abuse treatment.