Healthcare Administrators: Applying the Guideline

Implementing the 2022 Clinical Practice Guideline

The 2022 Clinical Practice Guideline includes information that updates and replaces the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain. It offers evidence-based recommendations for providing primary and outpatient pain care for short- and long-term pain (acute, subacute, and chronic pain) for adults aged 18 years and older. The recommendations exclude pain management related to sickle cell disease, cancer-related pain treatment, palliative care, and end-of-life care.

Updating and establishing policies

The 2022 Clinical Practice Guideline can inform healthcare policies and standards that improve safety and effectiveness of pain treatment, by:

• Improving function for patients.
• Improving quality of life for patients.
• Reducing risks associated with opioid pain therapy.

Health systems are encouraged to review pain management policies and standards and consider updating them based on the 2022 Clinical Practice Guideline recommendations. Additionally, health systems can:

• Review state-mandated protocols and standards about pain management and requirements related to prescription opioids.
• Train clinical staff on policies and protocols for starting, continuing, or ending pain treatment with opioids.
• Look for ways to address health inequities, strengthen patient-clinician communication, leverage community health workers, implement multidisciplinary care teams, and support guideline-concordant care for all patients.
• Avoid misapplying the 2022 Clinical Practice Guideline by developing policies and standards that are inconsistent with its purpose or go beyond its intended use.

Policies and practices to support clinicians and patients in making appropriate pain care decisions:

• Do not set rigid dosage thresholds. Payers and health systems should not use the 2022 Clinical Practice Guideline to set rigid standards related to dosage or duration of opioid therapy. The Guideline is not a replacement for clinical judgment or individualized, patient-centered care. It is intended to be a flexible clinical tool.
• Support slow tapers. Policies should not result in rapid tapers or abrupt discontinuation of opioids.
• Ensure that clinicians are not penalized for accepting new patients who are taking opioids and are not incentivized to implement rapid tapering.
• Attend to health inequities by providing culturally and linguistically appropriate communication for clinicians, practices, health systems, and payers, including accessible communication for persons with disabilities.
• Ensure access to appropriate, affordable, diversified, coordinated, and effective pain management regimens for all.
• Offer or arrange treatment with medications for opioid use disorder (MOUD), especially if opioid use disorder (OUD) is moderate or severe.
• Options include office-based buprenorphine or naltrexone treatment, or an opioid treatment program certified by Substance Abuse and Mental Health Services Administration to provide methadone or buprenorphine for patients with OUD.

Engaging and educating staff

Systemwide clinician and clinical care team education and training are crucial to support practice changes that provide safer and more effective pain treatment. CDC provides free online training and resources to support clinician education on the following topics, many of which include continuing education credits.

Nonopioid therapies

The 2022 Clinical Practice Guideline recommends that all patients receive treatment for pain that provides the greatest benefits relative to the risks. The guideline encourages maximizing the use of nonopioid therapies as appropriate. Health systems can improve care by increasing access to nonopioid therapies that can be integrated in patients' pain management plans.

Opioid prescribing

The 2022 Clinical Practice Guideline provides recommendations to encourage safer and more effective prescribing of opioids when benefits for pain and function are expected to outweigh the risks for opioid use. Here are resources to share with clinicians that support them in making decisions:

• Initiating Opioid Therapy
• Continuing Opioid Therapy
• Tapering training mini-module
• Naloxone (resources and training modules)
• The 2022 Clinical Practice Guideline for Prescribing Opioids for Pain training module

Assessing and addressing opioid use disorder (OUD)

The 2022 Clinical Practice Guideline recommends that clinicians should offer or arrange treatment with evidence-based medications to treat patients with OUD. Health systems can educate clinicians about identifying OUD using DSM-5 criteria and discussing concerns about OUD with patients in a non-judgmental manner. For patients meeting criteria for OUD, clinicians should offer or arrange treatment with MOUD, which has been associated with reduced overdose and overall mortality. Here are some resources you can share with clinicians to support them in identifying and treating OUD:

• Assessing and Addressing Opioid Use Disorder training module
• Addiction Medicine Toolkit (resources and training modules)
• Buprenorphine for the Treatment of Opioid Use Disorder training mini-module

Prescription Drug Monitoring Programs (PDMPs)

1. The 2022 Clinical Practice Guideline recommends that clinicians review a patient’s history of controlled substance prescriptions using a state PDMP before writing an opioid prescription for acute, subacute, or chronic pain. This practice is recommended in all jurisdictions where access makes this practicable (e.g., clinician and delegate access permitted). Health systems can encourage the integration of PDMPs with electronic health records (EHRs) to reduce burden on their clinicians by limiting the number of separate systems used. At a minimum, clinicians should review the PDMP data for initial opioid prescriptions and then every three months or more during long-term opioid therapy. (Recommendation 9).

Toxicology tests can provide information about prescribed medications as well as other prescribed and nonprescribed controlled substances that are not reported by the patient. For more information, please refer to Recommendation 10.

Other useful Resources

• Motivational Interviewing training module
• CDC's PDMP webpage

Electronic clinical decision support (CDS) tools to support implementation

Electronic clinical decision support (CDS) tools are integrated into some electronic health records (EHR) and other similar systems. CDS tools can provide accurate and timely information to enhance clinical decision-making within the patient encounter to improve health and healthcare delivery. The data from the EHR can be used, for example, to analyze organizational practices and progress. For more about electronic CDS tools, visit Electronic CDS Tools: Safer Patient Care for Opioid Prescribing.

Integrating the 2022 Clinical Practice Guideline recommendations into electronic CDS tools can equip health systems with the data and resources they need to help clinicians quickly assess the following:

• When it is appropriate to initiate opioids to treat pain.
• Safer ways to maintain or discontinue use in patients who are currently on long-term opioid therapy.
• How to measure pain and functioning.
• When to offer or arrange MOUD to treat patients with OUD.
• When to offer interventions such as prescribing naloxone, and when to use urine drug/toxicology testing.

The Office of the National Coordinator for Health Information Technology and CDC worked collaboratively to convert the 2022 Clinical Practice Guideline recommendations into shareable electronic CDS tools for EHRs. Supporting clinicians' access to evidence-based guideline concordant CDS tools can promote safer prescribing and help improve care and management for pain. Learn more about integrating CDS tools into your health practice or system's EHR, by visiting the Electronic CDS Tools: Safer Patient Care for Opioid Prescribing webpage.

Additional resources

CDC offers additional resources to support implementation of the 2022 Clinical Practice Guideline. These include:

• 2022 Opioid Prescribing Support Implementation Guide
• Linking People with Opioid Use Disorder to Medication Treatment
• Health Equity

Additionally, the following resources provide more information about pain management for conditions excluded from the clinical practice guideline.

• Managing Chronic Pain if You Have Sickle Cell Disease
• Managing Acute Pain if You Have Sickle Cell Disease
• National Coalition for Hospice and Palliative Care Clinical Practice Guidelines for Quality Palliative Care 4th Edition
• Clinical Practice Guidelines in Oncology: Adult Cancer Pain