CDC: Opioid prescribing guidelines ‘misimplemented’
The CDC Guidelines for Prescribing Opioids for Chronic Pain are not consistently followed, putting patient health and safety at risk, according to a perspective recently published in The New England Journal of Medicine.
“In situations for which the evidence is limited, it is particularly important not to extend the implementation beyond the guideline’s statements and intent. And yet in some cases, the guideline has been misimplemented in this way,” Deborah Dowell, MD, MPH, of the CDC, and colleagues wrote.
The following inconsistencies with the guidelines were recently identified by a consensus panel, researchers wrote:
- Applying the guideline to patients engaging in active cancer treatment, experiencing acute sickle cell crises or post-surgical pain and/or those participating in medication-assisted treatment for opioid use disorder;
- Ceasing opioids that have already been prescribed at doses of 90 morphine milligram equivalents a day or more; and
- Abrupt tapering or sudden stopping of opioid use.
The NEJM report is not the first to suggest possible misuses of the CDC opioid guidelines. Healio Primary Care Today reported earlier this year that though the CDC guidelines were not meant to be model legislation for states to act on, 28 states did so.
In a separate press release, the AMA said it “welcomed” the findings reported by Dowell, et al.
“The AMA appreciates that the CDC recognizes that patients in pain require individualized care and that the agency’s 2016 guidelines on opioids have been widely misapplied. The guidelines have been treated as hard and fast rules, leaving physicians unable to offer the best care for their patients,” Patrice A. Harris, MD, the organization’s opioid task force chair said in a statement.
She added that reversing the harm by such inaccuracies will be a “challenge,” and suggested some steps for facilitating the process.
“The AMA is urging a detailed regulatory review of formulary and benefit design by payers and [pharmacy benefit managers] to ensure that patients have affordable, timely access to medically appropriate treatment, pharmacologic and non-pharmacologic. The nation’s physicians will work with CDC so our patients receive comprehensive, multidisciplinary, multimodal pain care based on medical science and effective clinical practice.”
Dowell and colleagues wrote in the NEJM piece that clinicians are encouraged to use the CDC’s pocket guide to assist them in tapering methods, its app and website that provide motivational interviewing tips, and its information about nonopioid treatments for pain.
Physicians are also encouraged to bookmark Healio’s Opioid Resource Center. This collection of news articles and features covering multiple medical specialties provides the latest information on the opioid crisis including treatment strategies, FDA decisions regarding treatments and other important, related announcements.
The CDC is “working to identify ways to integrate recommendations into medical education and to support best practices among the next generation of medical professionals,” Dowell and colleagues wrote. – by Janel Miller
Disclosures : The authors report being among the authors of the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain.
Filed under: General Problems
The cdc ought to know what an epidemic IS,
And it is in Pain, not prescribing.
And we all warned of this outcome when the “guidelines” were issued, after secret meetings and a 48 hour comment period.
The CDC was never empowered by any agency to issue the guidelines in the first place: FDA has regulatory control over prescription medication as has sine the CSA came out in 1970.
So:
Those who give a weak MEA CULPA for misinterpretation of the guidelines are, in short, lying. The deaths of thousands of abandoned pain patients, including 6 of mine who lost access, are on their hands.
On a calmer note,
Yet another misinterpretation of the guidelines is the fearful and anxious failure of pain clinics to allow legal medical cannabis use in their pain patients, leaving many to choose between cannabis and opiates, when clear evidence shows that medical cannabis users use fewer opiates, and cannabis provides access to an EXIT from opiates, and for that matter from all opioids.
The other elephant in the room:
DEA, who is misinterpreting the CSA as well as the CDC guidelines to justify:
Arresting and punishing doctors who treat the sickest pain patients
Civil asset forfeiture as used in dealing with criminal drug dealers
Equate physicians with a license to practice as equal to or below said criminal drug dealers.
Charge physicians with one felony for every Rx they write, making absurdly dramatic charging documents and headlines against doctors who are left with no income or assets to defend themselves in a contaminated jury pool.
Charge doctors with murder for prescribing medications to patients who fail to follow the directions
The standard of care is now determined by prosecutors and juries who lack the complex abilities of physicians, and lack the physician patient relationship as a reference.
Yes
The CDC guidelines have been as harmful as predicted, and the silence over 3 years has been criminal.
The “who me”?
Response is just as evil as the ignorant abuse of power that led to the crisis in the first place.
Mark Ibsen MD
Helena MT.
To who ever it concerns thank you so much. please feel free to publicly post and use this my story and grief of this horrible malady and the Hell the now uninformed Public and some of the Media are putting us legitimate Chronic Pain Sufferers through! It is no more than local emotional Abuse ( and border line Domestic Emotional Terrorism )!on a scale with only Biblical proportions!To the Editor and Associates I have taken this opportunity to share my heartbreaking story in hopes these witch hunting Opiate ill informed skeptics will read and understand that we as Millions Of Legitimate Chronic Pain Sufferers would have no life without Medically prescribed Opiates by a physicians care and strictly monitored monthly urine and blood test. Please remember that An Opinion Before A Thorough Investigation Is The Epitome Of Ignorance! And that a little more compassion from the Medical Field and its representatives could have saved my beautiful Stepdaughters life. Let me say this! A person who has a addictive personality will abuse anything that helps them feel better. I had taken Oxycontin for 12 years , I have had 20 major surgery’s in 9 years. I have so much physical pain all 24 .
I pray God you pain med skeptics never go through what I go through everyday of my life when the only thing you have to do is threaten what help I get, Shame on them! There will always be drug abuse and as the so called war on drugs has failed all this will! All you do is stoke and aid the drug pushers business to knew heights in the Black Market of Heroin while trying to deprive folks as me to this horrible movement! My Stepdaughter committed suicide 4 years ago because of being treated like a drug addict by her family and doctors when all along she suffered from Lupus and Fibromyalgia which I believe was brought on by a deadly car crash at 18 , she told me between that which I was being put through and what they were putting her through she was not going to be able to live her life in such a hell brought on by people like the Biased Uniformed Skeptics that are on a witch hunt to out law Opiates and pain meds that give us some sort of a life .
As a retired Police officer and worked indirectly close to the DEA, you people do not have a clue how thrilled you are making the illegal opiate trade and think of my Late Stepdaughter as you continue on with this 2017 Version of the ( 1940s Propaganda Film named REEFER MADNESS )movement to outlaw opiates! Just like the slaughter of children at Sandy Hook if there would have just been gun laws , my God they were Gun Laws , the guns that murdered all those 20 children were all registered and owned by a school teacher! You fight Drug Addiction in Elementary education by teaching all children the dangers of Booze and Tobacco which if these witch hunters want for us to know the real truth but they do not. I miss my Stepdaughter so much and some of us will continue on the fight to protect our right to feel better and function without fear of these witch hunters trying to convince us to commit suicide . And they are trying to do exactly THAT and are now being successful in this under the table practice of Human Genocide!
The under line real truth it seems THESE witch hunters would rather us Chronic Pain sufferers commit suicide are and DRINK all the BOOZE we can drink! The Federals legalized it ( ALCOHOL) knowing its a more deadly drug than Strychnine. And just because the DEA has miserably failed with their witch hunt type movement on drugs why do they continuous fully deprive us sick people of our Constitutional Rights to be Happy in that pursuit of with Profes sional Physicians to take meds that give us relief of this horrible malady of Chronic Pain ! May God have mercy on their miserable souls they that seek to destroy us Chronic Pain Sufferers only and little hope of temporary relief of this horrible sickness.