How The CDC's Opioid Prescribing Guideline Hurts Chronic Pain Patients

By Keri Blakinger 12/10/18

“Conflating the misuse of opioids with their legitimate medical use, and treating all opioids alike is stigmatizing patients for whom opioid painkillers are necessary and medically appropriate,” writes one expert.

woman who is a chronic pain patient won't receive pain meds because of CDC guidelines

The heavy-handed misapplication of the Centers for Disease Control and Prevention’s opioid-prescribing guideline is hurting legitimate pain patients, according to a STAT News opinion piece penned last week by two health law attorneys and a doctor. 

“The CDC guideline and its progeny of laws and policies have created chaos and confusion in the medical community,” the experts wrote in their Dec. 6 essay.

“Conflating the misuse of opioids with their legitimate medical use, and treating all opioids – illegal or prescription – alike is stigmatizing patients for whom opioid painkillers are necessary and medically appropriate.”

The guideline, published in early 2016, suggests restrictions on the daily dosage of painkillers, though the suggestions are not intended to apply to existing long-term pain patients.

And in theory, the CDC guidelines aren’t mandatory – they’re simply guidelines. But insurance companies, lawmakers and pharmacies have relied on them to craft sweeping policies, the authors wrote, effectively treating long-term pain patients as suspected drug addicts. 

That’s despite the fact that – even as overdose deaths continue to rise – opioid prescribing is on the downswing and currently is at an 18-year low. 

Some research shows that most people who abuse painkillers don’t get them from doctors. And, most people who are prescribed painkillers don’t become addicted, even if they become physically dependent. 

Even so, the authors wrote, doctors are reportedly dropping patients for fear of blowback as the Drug Enforcement Administration (DEA) and state medical boards continue using those guidelines to identify suspected over-prescribers. 

“Some physicians are telling their patients that changes in the law are the reason they are tapering them to a preset dosage of opioids or off of opioids altogether,” the experts wrote. “Yet the specific dosage thresholds in the CDC guideline were never intended to apply to patients currently taking opioids. Indeed, nothing in the current legal or regulatory environment justifies forcibly tapering a patient off of opioids who is doing well, and there is no solid evidence to support such a practice.”

This isn’t a new complaint; it’s a problem previously documented by reporters and researchers. But now the American Medical Association is weighing in; at their most recent interim meeting, the physicians group approved resolutions striking out against the spate of laws and mandated restrictions imposing blanket limitations on prescribers.

The resolutions won’t change outside policy, but they represent a formal effort to push back against the mandates of lawmakers, pharmacies and insurers.

“The resolutions underscore that dosage guidance is just that – guidance – and that doses higher than those recommended by the CDC may be necessary and appropriate for some patients,” the authors wrote.

“Epidemics instill fear, but physicians have a responsibility to rise above fear and advance the interests of their patients. The AMA’s action in advocating for patients and for the right of physicians to practice individualized care is an important effort in beginning to rebalance the scales in the joint goals of reducing pain and opioid addiction.”

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Keri Blakinger is a former drug user and current reporter living in Texas. She covers breaking news for the Houston Chronicle and previously worked for the New York Daily News and the Ithaca Times. She has written about drugs and criminal justice for the Washington Post, Salon, Quartz and more. She loves dogs and is not impressed by rodeo food. Find Keri on LinkedIn and Twitter.