The Potential Impact on Children of the CDC Guideline for Prescribing Opioids for Chronic Pain

In an effort to address the epidemic of opioid misuse and related deaths from overdose in the United States, the Centers for Disease Control and Prevention (CDC) produced the 2016 CDC Guideline for P re s c r i b i ng O p i o i d s fo r Chronic Pain. 1 This document is intended to offer "recommendations for prescribing opioids for chronic pain outside of active cancer, palliative, and end-of-life care." 1 The guideline focuses largely on the risks and benefits of opioid treatment and attempts to offer evidence to support their safe, efficacious, and appropriate use.The current concerns about opioids ensure that this document will receive widespread scrutiny and that there will be extensive discussion regarding the 12 recommendations that are made in the guideline.1 It is a certainty that some will argue that the recommendations unnecessarily restrict opioid use and that individuals will suffer unnecessarily as a result; others may feel that the recommendations are too lenient regarding opioid indications and will promote further opioid abuse and dependence.Most will argue that the evidence supporting the recommendations is inadequate to justify the conclusions that have been reached.For better or worse, in theory, none of this is germane to the pediatric community because the guideline states in its second paragraph that it is intended to apply to patients 18 years of age or older with chronic pain.Unfortunately, the exclusion of children from the national discussion on pain is not new.The Interagency Pain Research Coordinating Committee on the National Pain Strategy likewise did not consider children in their public draft.2 While there may be some potential secondary benefit to the pediatric population from the guideline if it does, in fact, limit the excess availability of opioids and the potential for inadvertent opioid poisoning in young children and pilfered recreational use by adolescents, clearly children and adolescents would benefit from guidelines tailored to their needs.We are concerned, however, that because this guideline is written for primary care clinicians, family physicians and pediatricians will assume that they can be extrapolated downward to the pediatric population for whom it was not intended.There are understandable reasons why children are not included in these discussions.The methodological and ethical complexities involved in pediatric pain research have dampened the interest of the research community, and the relatively small market for analgesia that children offer has lim-Opinion