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Federal health officials on Thursday abandoned their influential recommendations that opioid prescribers should aim for certain dose thresholds when treating chronic pain. The changes came as part of a proposed update to the Centers for Disease Control and Prevention’s controversial 2016 guidelines on opioid prescribing. The recommendations are an attempt from health officials to strike a balance between limiting the harms that can come from long-term opioid use; allowing for physicians to come up with individualized plans to treat their patients; and encouraging reductions in dosages when it can be done safely and with patient buy-in. The newer guidelines still say that “opioids should not be considered first-line or routine therapy for subacute or chronic pain” and note that other treatments are often better for acute pain as well. Doctors should prioritize non-opioid medications and interventions like exercise and physical therapy, according to the recommendations. (Joseph, 2/10)

Though still in draft form, the 12 recommendations, issued by the Centers for Disease Control and Prevention, are the first comprehensive revisions of the agency’s opioid prescribing guidelines since 2016. They walk a fine line between embracing the need for doctors to prescribe opioids to alleviate some cases of severe pain while guarding against exposing patients to the well-documented perils of opioids. Dr. Samer Narouze, president of the American Society of Regional Anesthesia and Pain Medicine, an association of clinicians, praised the tone, level of detail and focus of the project. “It’s a total change in the culture from the 2016 guidelines,” he said, characterizing the earlier edition as ordering doctors to “just cut down on opioids — period.” (Hoffman, 2/10)

The 229-page document advises doctors to limit new opioid prescriptions and discuss alternative therapies with patients. But the new guidance largely avoids figures on dosage and length of prescription and warns against abruptly or rapidly discontinuing pain pills for some chronic pain patients. "We've built in flexibility so that there's not a one-size-fits-all approach," said Christopher Jones, acting director of the CDC's National Center for Injury Prevention and Control. (Alltucker, 2/10)

One expert expressed initial wariness about a proposed revision. The 2016 guidance succeeded in helping to reduce inappropriate and dangerous prescribing, said Dr. Adriane Fugh-Berman of Georgetown University Medical Center. Its critics have included pain patients, but also painkiller manufacturers and groups they fund, she said. “There was nothing wrong with the original guidelines,” said Fugh-Berman, a paid expert witness for plaintiffs in cases targeting pharmaceutical marketing practices. (Stobbe, 2/10)

Doctors have wide latitude to prescribe drugs, including potentially dangerous ones, but even they face limits. The question is, what threshold do physicians have to cross — and what sort of intent do they need to have — for their prescribing to be considered a crime? It’s an issue headed to the Supreme Court next month, in a case concerning two physicians who were convicted of unlawfully dispensing opioid painkillers. The case is already raising alarms among advocates for pain patients and some health policy experts, who fear that a ruling could enable aggressive prosecutions of prescribers. They warn that such a decision could discourage doctors from providing opioids even when they’re warranted, at a time when some pain patients are already losing access to medication or seeing their doses unsafely slashed. Advocates are asking the court to make clear that criminal punishments should be reserved for prescribers who knowingly write inappropriate prescriptions. (Joseph, 2/11)

Members of the billionaire Sackler family that own Purdue Pharma LP are weighing whether to add $1 billion to the OxyContin-maker’s faltering opioid settlement bid in an effort to win over holdouts, according to people familiar with the offer. The move would bring the family’s total contribution to $5.325 billion to get a handful of state attorneys general to drop their opposition to Purdue’s bankruptcy plan, the people said. In return, the states would abandon appeals of the Sacklers’ demands to be freed from liability in current and future opioid lawsuits, the people added. (Feeley, Hill and Nayak, 2/10)

In 2017, Philadelphia was on track to see a record-breaking overdose death toll. Calls were growing to open a supervised injection site, where people can use drugs under medical supervision and be revived if they overdose. By the end of the year, 1,217 people had died of an overdose, and city officials made the decision to sanction a site but not pay for it. Five years later, the city still has no site, and the deaths go on. Still, advocates see renewed hope in the fact that the Justice Department under President Joe Biden signaled this week it is reconsidering the Trump administration’s long-held opposition to such efforts. Here’s a timeline of key moments in the process... (Whelan and Roebuck, 2/10)