Get Ready! EW PharmD Reviews the 2021 Draft CDC Guidelines for Prescribing Opioids

November 2, 2021

The CDC Guideline for Prescribing Opioids for Chronic Pain – United States, 2016, provided 12 recommendations for prescribing opioid pain medications for outpatients aged ≥ 18 years in primary care settings for non-cancer pain. In order to identify whether evidence gaps are sufficiently addressed to warrant updates to, or expansion of, the Guideline, CDC funded the Agency for Healthcare Research and Quality to conduct five systematic reviews on the effectiveness of opioid, nonopioid pharmacologic, and nonpharmacologic treatments for acute and chronic pain. Preliminary evidence from draft updated systematic reviews pertaining to chronic pain treatment suggests that a guideline update should be considered. The updated guideline is anticipated to be released during late 2021.

The below table provides a summary of the Guideline recommendations.


ExamWorks Compliance Solutions’ Doctors of Pharmacy offer opioid risk-benefit evaluation, potential opioid tapers, risk mitigation strategies, optimization of nonopioid agents, alternatives to high cost Medicare-covered medications, and clarification of drug regimens to provide the most accurate and defensible MSA. The goal of the program is to impact medication therapy to improve safety and clinical outcomes, and mitigate MSA drug costs by consulting with the treating provider on the clinical rationale for the medication regimen. ExamWorks utilizes technology and compendia databases, which are recognized and supported by the CMS to support inclusion or exclusion of a drug under the Part D benefit. We will continue to monitor changes in medication pricing as well as availability of generic equivalents within the marketplace.   

For questions about medications, please contact Nahla D. Rizkallah, PharmD, MSCC, at 678.256.5086 or

Nahla Rizkallah, PharmD, MSCC

Nahla Rizkallah, PharmD, MSCC

Nahla D. Rizkallah, PharmD, MSCC, serves as the Senior Clinical Pharmacist at ExamWorks Compliance Solutions. In this capacity, she performs prescription analysis to optimize drug therapy using evidence-based guidelines and national guidelines, and participates in physician outreaches to implement the recommendations. She has 29 years of experience in various area of pharmacy practice including: review of Part D medications on Medicare Set-Aside Allocations, prior authorization reviews for the Florida Medicaid program as Senior Clinical Pharmacist, development of drug utilization criteria, academic detailing, Pharmacy and Therapeutics Committee, Pharmacy Manager for a closed mental health facility, Pharmacy Manager for the indigent, staff/clinical pharmacist for assisted- living facilities (ALFs), medication audits for ALFs, drug information center, clinical pathways, staff education, and surgical/medical pharmacy satellite at All Children’s Hospital. Dr. Rizkallah has the following certifications: Medicare Set-Aside Certified Consultant, Hypertension and Dyslipidemias, and Diabetes. Dr. Rizkallah received her Doctorate from the University of Florida in Gainesville followed by a one year American Society of Health-System Pharmacists accredited residency.

For questions about medications or the ExamWorks Compliance Solutions Pharmacy programs, please contact Nahla D. Rizkallah, PharmD at 678.256.5086 or