Medications, Pharmacology: What are the new guidelines for prescribing opioids?

October 8, 2025 •

3 min read

The CDC's 2022 Clinical Practice Guideline for Prescribing Opioids replaced the more rigid 2016 version, focusing on flexible, patient-centered care. Understanding what are the new guidelines for prescribing opioids? is crucial for clinicians aiming to balance effective pain management with the ongoing need to mitigate overdose risk, expanding the scope to include care for acute, subacute, and chronic pain.

Quick Summary

The latest opioid prescribing guidelines emphasize a flexible, patient-centered approach over rigid rules, prioritizing non-opioid therapies and requiring thorough risk assessment. The 2022 CDC update, alongside evolving federal and state regulations, focuses on shared decision-making, careful dosage titration, and harm mitigation, including naloxone co-prescribing.

Key Points

Patient-Centered Approach: The 2022 CDC guidelines emphasize a flexible, individualized, and patient-centered model over rigid prescribing rules, promoting shared decision-making.
Non-Opioid First: For acute, subacute, and chronic pain, non-opioid therapies (pharmacologic and nonpharmacologic) are prioritized over opioids.
Start Low and Go Slow: The lowest effective dose of immediate-release opioids should be prescribed for opioid-naïve patients, with extended-release versions reserved for specific cases.
Continuous Reassessment: The benefits and risks of continued opioid therapy must be reassessed regularly, with a plan for tapering if benefits no longer outweigh harms.
Mandatory Monitoring: Clinicians must use Prescription Drug Monitoring Program (PDMP) data before initiating opioid therapy and throughout treatment to assess risk.
Harm Mitigation: Strategies like co-prescribing naloxone for at-risk patients and avoiding concurrent benzodiazepine use are central to preventing overdose.
Updated 2025 Rules: Ongoing regulatory changes, such as Medicare Part D's MME threshold alerts and evolving DEA telemedicine rules, necessitate continuous vigilance by prescribers.

Core Principles of the 2022 CDC Guidelines

The 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain updates the 2016 version, promoting individualized, patient-centered care for adults aged 18 and older with acute, subacute, or chronic pain. It emphasizes a flexible approach, moving away from rigid standards to better address diverse patient needs and circumstances. The guideline underscores a multimodal approach to pain management, integrating various therapies for a holistic plan. It also stresses the importance of equitable access to effective pain treatment and avoiding misapplication that could harm patients or deny necessary care.

Key Recommendations for Opioid Therapy

Initiating and Selecting Opioid Therapy

Opioids are not recommended as first-line therapy for subacute or chronic pain; nonpharmacologic and nonopioid options should be maximized first. For opioid-naïve patients, prescribe the lowest effective dose of immediate-release opioids. Before starting therapy, discuss realistic goals and have a plan if treatment is ineffective or risks outweigh benefits.

Continuing Opioid Therapy and Follow-up

Regularly reassess patient benefits and risks, especially within the first month and at least every three months for long-term therapy. Use caution when increasing doses, particularly at or above 50 MME/day, and carefully justify doses at or above 90 MME/day. If benefits don't outweigh harms, develop a tapering plan with the patient, avoiding abrupt discontinuation unless life-threatening.

Mitigating Harm and Assessing Risk

Utilize state Prescription Drug Monitoring Programs (PDMPs) before starting and throughout therapy to identify risks. Avoid co-prescribing opioids and benzodiazepines due to increased overdose risk. Consider co-prescribing naloxone for patients at higher overdose risk. Periodic urine drug testing can screen for controlled and illicit substances.

Non-Opioid Treatment Alternatives

Consider a range of non-opioid options, including nonpharmacologic therapies like physical therapy, mind-body practices, psychological therapies, manual therapy, massage, and acupuncture, as well as nonopioid pharmacologic therapies such as acetaminophen, NSAIDs, topical analgesics, antidepressants, and anticonvulsants.

2016 vs. 2022 CDC Opioid Guidelines: A Comparison

The 2022 update marks a shift from the 2016 guideline:


Feature	2016 CDC Guideline	2022 CDC Guideline Update
Application	Often misinterpreted as rigid rules.	Emphasizes voluntary recommendations and flexible, patient-centered care.
Dosage Thresholds	Often applied as hard limits.	Presented as 'guideposts' for careful consideration, not rigid caps.
Scope of Pain	Focused primarily on chronic pain.	Expanded to include acute, subacute, and chronic pain.
Patient-Centeredness	Less explicit focus on shared decision-making.	Shared decision-making is a critical component.
Clinician Audience	Focused primarily on primary care providers.	Broadened to include a wider range of clinicians.

2025 Updates in Opioid Regulations

Be aware of ongoing regulatory changes. As of January 1, 2025, Medicare Part D includes care coordination alerts for cumulative opioid dosages reaching 90 MME/day. DEA regulations for telemedicine prescribing of OUD medications like buprenorphine have been extended through December 31, 2025, but with stricter oversight planned.

Conclusion

Navigating pain management requires a flexible, patient-centric approach beyond strict dosage limits. What are the new guidelines for prescribing opioids? highlights a shift towards comprehensive care using diverse non-opioid therapies. The 2022 CDC guidelines and subsequent regulations provide a framework for safe and effective pain treatment while mitigating opioid risks through risk assessment, communication, shared decision-making, and individualized treatment plans.

More detailed information can be found on the CDC's Overdose Prevention website.

Frequently Asked Questions

The main difference is the shift from a more rigid, rules-based approach in 2016 to a more flexible, patient-centered model in 2022. The new guidelines emphasize shared decision-making and avoid applying dosage thresholds as inflexible standards.

No, the new guidelines do not establish a hard dosage cap. Instead, they present morphine milligram equivalent (MME) thresholds as 'guideposts,' prompting careful reassessment and justification for higher dosages, rather than functioning as rigid limits.

Non-opioid therapies are strongly prioritized. Clinicians are encouraged to maximize nonpharmacologic and nonopioid pharmacologic treatments first and consider opioids only when the benefits for pain and function are anticipated to outweigh the risks.

Clinicians should consider co-prescribing naloxone for patients at an increased risk of opioid overdose. This includes patients on higher doses, those using concurrent central nervous system depressants like benzodiazepines, or with a history of opioid use disorder.

Recent updates in 2025 include Medicare Part D alerts for cumulative dosages exceeding 90 MME/day, prompting pharmacist-prescriber coordination. DEA regulations regarding telemedicine for opioid use disorder (OUD) also continue to evolve, with extensions for some flexibilities but increased oversight.

Opioid therapy should not be stopped abruptly unless it's a life-threatening situation. When tapering is necessary, it should be done gradually and with the patient's involvement, moving toward discontinuing the therapy or reducing the dosage to optimize other pain management approaches.

No, the 2022 guidelines expanded their scope to apply to a broad range of clinicians, including surgeons, dentists, emergency physicians, and other specialists who prescribe opioids in outpatient settings.