The DOI matches its Crossref record; 214 of the 215 references it cites were found in a registry or an index; none of the 23 sources its claims cite is checked for support yet.
CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016
Open accessAbstract
IMPORTANCE: Primary care clinicians find managing chronic pain challenging. Evidence of long-term efficacy of opioids for chronic pain is limited. Opioid use is associated with serious risks, including opioid use disorder and overdose. OBJECTIVE: To provide recommendations about opioid prescribing for primary care clinicians treating adult patients with chronic pain outside of active cancer treatment, palliative care, and end-of-life care. PROCESS: The Centers for Disease Control and Prevention (CDC) updated a 2014 systematic review on effectiveness and risks of opioids and conducted a supplemental review on benefits and harms, values and preferences, and costs. CDC used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework to assess evidence type and determine the recommendation category. EVIDENCE SYNTHESIS: Evidence consisted of observational studies or randomized clinical trials with notable limitations, characterized as low quality using GRADE methodology. Meta-analysis was not attempted due to the limited number of studies, variability in study designs and clinical heterogeneity, and methodological shortcomings of studies. No study evaluated long-term (≥1 year) benefit of opioids for chronic pain. Opioids were associated with increased risks, including opioid use disorder, overdose, and death, with dose-dependent effects. RECOMMENDATIONS: There are 12 recommendations. Of primary importance, nonopioid therapy is preferred for treatment of chronic pain. Opioids should be used only when benefits for pain and function are expected to outweigh risks. Before starting opioids, clinicians should establish treatment goals with patients and consider how opioids will be discontinued if benefits do not outweigh risks. When opioids are used, clinicians should prescribe the lowest effective dosage, carefully reassess benefits and risks when considering increasing dosage to 50 morphine milligram equivalents or more per day, and avoid concurrent opioids and benzodiazepines whenever possible. Clinicians should evaluate benefits and harms of continued opioid therapy with patients every 3 months or more frequently and review prescription drug monitoring program data, when available, for high-risk combinations or dosages. For patients with opioid use disorder, clinicians should offer or arrange evidence-based treatment, such as medication-assisted treatment with buprenorphine or methadone. CONCLUSIONS AND RELEVANCE: The guideline is intended to improve communication about benefits and risks of opioids for chronic pain, improve safety and effectiveness of pain treatment, and reduce risks associated with long-term opioid therapy.
Overview
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Claims the paper makes
17 Own result · 3 Not checked yet · 2 Own method · 2 No basis given · 1 Sources not found
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Of primary importance, nonopioid therapy is preferred for treatment of chronic pain. Opioids should be used only when benefits for pain and function are expected to outweigh risks.”
§ CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016 > Abstract > RECOMMENDATIONS
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“When opioids are used, clinicians should prescribe the lowest effective dosage, carefully reassess benefits and risks when considering increasing dosage to 50 morphine milligram equivalents or more per day,”
§ CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016 > Abstract > RECOMMENDATIONS
None of the sources cited for this claim could be matched to a paper in Crossref, so there is nothing to check it against.
In the paper
“Several nonpharmacologic and nonopioid pharmacologic treatments were found to be effective for chronic pain in studies ranging in duration from 2 weeks to 6 months48–66 (Table 3).”
§ CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016 > Guideline Development Process > Contextual Evidence Review
What the sources say
- Not matchedcites [48]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites [49]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites [50]
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- Not matchedcites [51]
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- Not matchedcites [52]
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- Not matchedcites [53]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites [54]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites [55]
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- Not matchedcites [56]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites [57]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matched
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“No study evaluated long-term (≥1 year) benefit of opioids for chronic pain.”
§ CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016 > Abstract > EVIDENCE SYNTHESIS
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The recommendations in the guideline are voluntary, rather than prescriptive standards. They are based on emerging evidence, including observational studies or randomized clinical trials with notable limitations.”
§ CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016 > Abstract > CONCLUSIONS AND RELEVANCE
None of the sources cited for this claim have been checked yet.
In the paper
“Studies examining patients who underwent low-risk surgery or experienced low back pain from injury revealed that opioid therapy prescribed for acute pain was associated with greater likelihood of long-term use.”
§ CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016 > Guideline Development Process > Clinical Evidence Review
What the sources say
- Not checked yetcites [46]
- Not checked yetcites [47]
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“No study evaluated the effectiveness of risk mitigation strategies.”
§ CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016 > Guideline Development Process > Clinical Evidence Review
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Evidence consisted of observational studies or randomized clinical trials with notable limitations, characterized as low quality using GRADE methodology.”
§ CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016 > Abstract > EVIDENCE SYNTHESIS
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Opioids were associated with increased risks, including opioid use disorder, overdose, and death, with dose-dependent affects.”
§ CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016 > Abstract > EVIDENCE SYNTHESIS
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Before starting opioids, clinicians should establish treatment goals with patients and consider how opioids will be discontinued if benefits do not outweigh risks.”
§ CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016 > Abstract > RECOMMENDATIONS
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The updated review revealed that evidence on long-term opioid therapy for chronic pain outside of end-of-life care remains limited, with insufficient evidence to determine long-term benefits, although evidence suggests risk of serious harms that is dose-dependent.”
§ CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016 > Guideline Development Process > Clinical Evidence Review
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“No study of opioid therapy vs placebo, no opioid therapy, or non-opioid therapy for chronic pain evaluated long-term (≥1 year) outcomes related to pain, function, or quality of life.”
§ CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016 > Guideline Development Process > Clinical Evidence Review
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Long-term opioid therapy was associated with problematic patterns of opioid use leading to clinically significant impairment or distress.”
§ CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016 > Guideline Development Process > Clinical Evidence Review
In the paper
“Initiation of therapy with an extended-release/long-acting(ER/LA) opioid was associated with greater risk of nonfatal overdose than initiation with an immediate-release opioid in 1 study, with risk greatest in the first 2 weeks after initiation of treatment.”
§ CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016 > Guideline Development Process > Clinical Evidence Review
What the sources say
- Not checked yetcites [33]
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The guideline is intended to improve communication about benefits and risks of opioids for chronic pain, improve safety and effectiveness of pain treatment, and reduce risks associated with long-term opioid therapy.”
§ CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016 > Abstract > CONCLUSIONS AND RELEVANCE
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There are 12 recommendations.”
§ CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016 > Abstract > RECOMMENDATIONS
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Clinicians should avoid prescribing opioid pain medication and benzodiazepines concurrently whenever possible.”
§ CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016 > Recommendations > Assessing Risk and Addressing Harms of Opioid Use
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain.”
§ CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016 > Recommendations > Determining When to Initiate or Continue Opioids for Chronic Pain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“When starting opioid therapy for chronic pain, clinicians should prescribe immediate-release opioids instead of extended-release/long-acting (ER/LA) opioids.”
§ CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016 > Recommendations > Opioid Selection, Dosage, Duration, Follow-up, and Discontinuation
None of the sources cited for this claim have been checked yet.
In the paper
“Opioid-related overdose risk was dose-dependent, with higher opioid dosages associated with increased overdose risk (Table2).”
§ CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016 > Guideline Development Process > Contextual Evidence Review
What the sources say
- Not checked yetcites Table2
- Not checked yetcites [19]
- Not checked yetcites [20]
- Not checked yetcites [21]
- Not checked yetcites [22]
- Not checked yetcites [23]
- Not checked yetcites [24]
- Not checked yetcites [25]
- Not checked yetcites [26]
- Not checked yetcites [27]
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Clinicians should evaluate benefits and harms with patients within 1 to 4 weeks of starting opioid therapy for chronic pain or of dose escalation. Clinicians should evaluate benefits and harms of continued therapy with patients every 3 months or more frequently.”
§ CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016 > Recommendations > Opioid Selection, Dosage, Duration, Follow-up, and Discontinuation
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“To provide recommendations about opioid prescribing for primary care clinicians treating adult patients with chronic pain outside of active cancer treatment, palliative care, and end-of-life care.”
§ CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016 > Abstract > OBJECTIVE
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The Centers for Disease Control and Prevention (CDC) updated a 2014 systematic review on effectiveness and risks of opioids and conducted a supplemental review on benefits and harms, values and preferences, and costs. CDC used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework to assess evidence type and determine the recommendation category.”
§ CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016 > Abstract > PROCESS
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Opioid use is associated with serious risks, including opioid use disorder and overdose.”
§ CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016 > Abstract > IMPORTANCE
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Evidence of long-term efficacy of opioids for chronic pain is limited.”
§ CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016 > Abstract > IMPORTANCE
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The cited source doesn’t support the claim as written.
In the citing paper
“A study of almost 100,000 patients found that the average rate of tapering was 34.0% of the original dose per month and more than a quarter of patients were tapering at a rate faster than 40% of their original dose per month,43,49 even higher than the maximum rate recommended by the CDC. 1”
From Tapering and withdrawing opioids: guidance informed by fundamental principles to minimise withdrawal symptoms (2025) · cites this paper as [1]
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“However, opioids are significantly less effective against chronic pain, such as neuropathic pain, fibromyalgia, and low-back pain, and tolerance develops to the analgesic effects of opioids, thus necessitating the need for increasingly higher doses to sustain analgesia (McQuay, 1988;Dowell et al., 2016).”
From Drug Addiction: Hyperkatifeia/Negative Reinforcement as a Framework for Medications Development (2021) · cites this paper as Dowell et al., 2016
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“The influential Centres for Disease Control (CDC) Guideline for Prescribing Opioids recommends a linear reduction of opioid doses: ‘A decrease of 10% of the original dose per week’ or ‘slower tapers (e.g. 10% per month)’ for longer term users (Figure 1(a)). 1”
From Tapering and withdrawing opioids: guidance informed by fundamental principles to minimise withdrawal symptoms (2025) · cites this paper as [1]
In the citing paper
“Opioids are also associated with substantial systemic harm such as worsening psychopathology, addiction, tolerance, and premature death. 24”
From Rome IV Functional Gastrointestinal Disorders and Health Impairment in Subjects With Hypermobility Spectrum Disorders or Hypermobile Ehlers-Danlos Syndrome (2021) · cites this paper as [24]
In the citing paper
“The Centers for Disease Control and Prevention and US Food and Drug Administration issued warnings in 2016 to make prescribers and patients aware of these risks.19,34”
From Patterns in Outpatient Benzodiazepine Prescribing in the United States (2019) · cites this paper as [34]
In the citing paper
“evidence of their longterm efficacy and safety is limited.6”
From Mind-Body Therapies for Opioid-Treated Pain: A Systematic Review and Meta-analysis (2020) · cites this paper as [6]
In the citing paper
“Although opioids are considered to be useful in managing a wide continuum of pain, including acute, procedural, and chronic pain”
From Mind-Body Therapies for Opioid-Treated Pain: A Systematic Review and Meta-analysis (2020) · cites this paper as [6]
Citations
Cites
Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,845
GRADE: an emerging consensus on rating quality of evidence and strength of recommendations
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GRADE guidelines: 3. Rating the quality of evidence
Balshem, H., Helfand, M., Schünemann, H. J., Oxman, A. D., Kunz, R., Brozek, J., Vist, G. E., Falck-Ytter, Y., Meerpohl, J., & Norris, S. (2011) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2010.07.015 · Cited by 8,285
Kroenke, K., Spitzer, R. L., Williams, J. B. W., & Löwe, B. (2010) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2010.03.006 · Cited by 4,057
GRADE guidelines: a new series of articles in the Journal of Clinical Epidemiology
Guyatt, G. H., Oxman, A. D., Schünemann, H. J., Tugwell, P., & Knottnerus, A. (2011) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2010.09.011 · Cited by 3,094
Hochberg, M. C., Altman, R. D., April, K. T., Benkhalti, M., Guyatt, G., McGowan, J., Towheed, T., Welch, V., Wells, G., & Tugwell, P. (2012) · Arthritis Care & Research · doi:10.1002/acr.21596 · Cited by 3,068
Zhang, W., Moskowitz, R. W., Nuki, G., Abramson, S., Altman, R. D., Arden, N., Bierma-Zeinstra, S., Brandt, K. D., Croft, P., Doherty, M., et al. (2008) · Osteoarthritis and Cartilage · doi:10.1016/j.joca.2007.12.013 · Cited by 2,796
Chou, R., Qaseem, A., Snow, V., Casey, D., Cross, J. T., Shekelle, P., Owens, D. K., & for the Clinical Efficacy Assessment Subcommittee of the American College of Physicians and the American College of Physicians/American Pain Society Low Back Pain Guidelines Panel* (2007) · Annals of Internal Medicine · doi:10.7326/0003-4819-147-7-200710020-00006 · Cited by 2,718
Self-citationCDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016
Dowell, D., Haegerich, T. M., & Chou, R. (2016) · MMWR. Recommendations and Reports · doi:10.15585/mmwr.rr6501e1 · Cited by 2,697
Self-citationPsychosomatic medicine in Germany: more timely than ever
Zipfel, S., Herzog, W., Kruse, J., & Henningsen, P. (2016) · Psychotherapy and Psychosomatics · doi:10.1159/000447701 · Cited by 2,323
Cited by
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Chronic pain: an update on burden, best practices, and new advances
Cohen, S. P., Vase, L., & Hooten, W. M. (2021) · The Lancet · doi:10.1016/s0140-6736(21)00393-7 · Cited by 2,614
Maher, C., Underwood, M., & Buchbinder, R. (2017) · The Lancet · doi:10.1016/s0140-6736(16)30970-9 · Cited by 2,535
Prevention and treatment of low back pain: evidence, challenges, and promising directions
Foster, N. E., Anema, J. R., Cherkin, D., Chou, R., Cohen, S. P., Gross, D. P., Ferreira, P. H., Fritz, J. M., Koes, B. W., Peul, W., et al. (2018) · The Lancet · doi:10.1016/s0140-6736(18)30489-6 · Cited by 2,398
Self-citationIncreases in drug and opioid-involved overdose deaths – United States, 2010-2015
Rudd, R. A., Seth, P., David, F., & Scholl, L. (2016) · MMWR. Morbidity and Mortality Weekly Report · doi:10.15585/mmwr.mm655051e1 · Cited by 2,194
New Persistent Opioid Use After Minor and Major Surgical Procedures in US Adults
Brummett, C. M., Waljee, J. F., Goesling, J., Moser, S., Lin, P., Englesbe, M. J., Bohnert, A. S. B., Kheterpal, S., & Nallamothu, B. K. (2017) · JAMA Surgery · doi:10.1001/jamasurg.2017.0504 · Cited by 2,025
Metadata
- Authors
- Dowell, D., Haegerich, T. M., & Chou, R.
- Affiliations
- Centers for Disease Control and Prevention (US)
- Corresponding author
- Dowell, Deborah
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2016-04-19
- Volume
- 315
- Issue
- 15
- Pages
- 1624
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC6390846
- OpenAlex
- W2296986887
- Cited by
- 5,161
- References
- 215
- Citations by year
- 2026: 137 · 2025: 233 · 2024: 272 · 2023: 347 · 2022: 407 · 2021: 733 · 2020: 825 · 2019: 762 · 2018: 701 · 2017: 525 · 2016: 214
- FWCI
- 723.61
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (CC999999)
- Agency for Healthcare Research and Quality
- U.S. Public Health Service (200-2013-M-53890, 15IPA-1505478, 290201200014I)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Pain Management
- Keywords
- opioid prescribing, chronic pain, opioid use disorder, opioid overdose, benzodiazepines, prescription drug monitoring programs, buprenorphine, methadone, medication-assisted treatment, low-dose opioids, primary care
- MeSH terms
- Contraindications, Adult, Analgesics, Opioid, Benzodiazepines, Centers for Disease Control and Prevention, U.S., Communication, Drug Therapy, Combination, Goals, Humans, Drug Prescriptions, Primary Health Care, United States, Randomized Controlled Trials as Topic, Treatment Outcome, Withholding Treatment, Chronic Pain, Acute Pain, Prescription Drug Misuse, Observational Studies as Topic
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