CDC clarifies opioid prescribing guidelines

In a letter released April 10, the CDC clarified its federal opioid prescribing guidelines were not meant to be unduly restrictive for chronic pain patients. The clarification came in response to repeated concerns that the rules were preventing patients from getting the pain care they needed. 

“The Guideline is not intended to deny any patients who suffer with chronic pain from opioid therapy as an option for pain management,” wrote Deborah Dowell, MD, MPH, chief medical officer of the CDC. “Rather, the Guideline is intended to ensure that clinicians and patients consider all safe and effective treatment options for patients.”

In the letter, Dowell explained that physicians are encouraged to use their best clinical judgement when it comes to opioid prescriptions. Nor was it their intention to deny chronic pain patients access to opioids, making special mention of sickle cell and cancer patients.  She also said that they’ll revisit the guidelines as new evidence and prescription recommendations become available. 

“Chronic pain is common and multidimensional, and patients deserve safe and effective pain management…CDC will continue to emphasize what the Guidelines and associated materials say about communication, patient engagement in decision making and maintenance of the patient-provider relationship.” 

The CDC published its Guideline for Prescribing Opioids for Chronic Pain in 2016. The guidelines consist of 12 recommendations [See sidebar] intended to reduce the use of opioids during an era of addiction and drug abuse. While the guidelines are voluntary,  many worried that they were too restrictive.

In March a group called the Health Professions for Patients in Pain (HP3) wrotethat the guidelines had made it too difficult to prescribe opioids to patients that need them.

“Consequently, patients have endured not only unnecessary suffering, but some have turned to suicide or illicit substance use,” HP3 wrote. “Others have experienced preventable hospitalizations or medical deterioration in part because insurers, regulators and other parties have deployed the 90 MME threshold as a both a professional standard and a threshold for professional suspicion. Under such pressure, care decisions are not always based on the best interests of the patient.”