The Centers for Disease Control and Prevention (CDC) is in the process of updating the 2016 opioid prescribing and monitoring guidelines. The open comment period closed in April 2022, and comments will be used to finalize the new guideline. As in the 2016 guideline, the new draft guideline, available online at https://downloads.regulations.gov/CDC-2022-0024-0002/content.pdf includes recommendations for testing (here referred to as toxicology testing) “to assess for prescribed medications as well as other prescribed and nonprescribed controlled substances” when prescribing opioids for subacute or chronic pain.
Key points within this draft guideline include the following:
- Because risk prediction is challenging and clinical tools do not allow reliable identification of patients at low risk for substance use disorder, “clinicians should consider toxicology screening results as potentially useful data, in the context of other clinical information, for all patients…”
- Toxicology testing should be considered prior to starting opioids and periodically thereafter, and should include testing for both prescribed medications “as well as other prescription and nonprescription controlled substances that increase risk for overdose when combined with opioids, including nonprescribed and illicit opioids and benzodiazepines.”
- Initial screening with presumptive immunoassays can be considered for cost control, but confirmatory testing may be needed to detect specific opioids, “such as those that are being prescribed and those that cannot be identified on standard immunoassays or on the presence of unexpected toxicology test results.” Clinicians should understand how to interpret results, including the limitations of immunoassays to detect some synthetic opioids
- Test results should not be used to dismiss patients from care, and physicians should explain this to patients as well as discuss the potential results and ask about use of prescribed and other drugs
In response to these draft guidelines, Jeff Gudin, MD, an anesthesiologist and pain management specialist at the University of Miami, Miller School of Medicine as well as senior medical advisor to Quest Diagnostics drug monitoring and toxicology franchise, said that toxicology testing is essential to physician’s understanding of what other drugs might be in a patient’s system and whether or not they are using their medication as prescribed. “We just think it is an error for [CDC] to lighten up on drug testing in the midst of our country’s greatest opioid epidemic ever,” he said.
Published date: June 28, 2022