Authors of the 2016 CDC Guidelines for Prescribing Opioids for Chronic Pain stated that prescribers misapplied the guidelines in a way that has been harmful to some patients with chronic pain.
In a commentary piece published in the New England Journal of Medicine, the authors stated, “In situations for which the evidence is limited, it is particularly important not to extend implementation beyond the guideline’s statements and intent. And yet in some cases, the guideline has been misimplemented in this way.”
The opioid prescribing guidelines are intended to address the current opioid crisis and reduce the number of opioid prescriptions. There was a downward trend in the overall number of opioid prescriptions since 2011. After the guidelines were published, there was also a reduction in prescriptions. However, some of this reduction may have been inappropriate.
It’s been noted that misinterpretation of the guidelines has led to:
- Doctors not considering the needs of certain patients with high-dose prescriptions
- Inflexible application of prescription durations
- The underutilization of naloxone
These practices have ultimately hurt some chronic pain patients who require opioid medications.
The guidelines were originally developed for primary care physicians, who prescribe the majority of opioids. The guidelines specifically addressed the treatment of chronic pain that is not associated with cancer or end of life treatment. However, it has been documented that patients with cancer, short-term pain, and participants of medication-assisted treatment for opioid use disorder have been subjected to the guidelines. This change led to inappropriate pain and addiction treatment in some patients.
Doctors are not the only ones to blame. Other groups in the healthcare industry including private insurers, state Medicaid programs and pharmacy benefit managers have used the guidelines to restrict access or payment for opioids.
The guidelines recommend that prescribers avoid daily opioid doses of greater than 90 morphine milligram equivalents (MME), or carefully justify a decision to prescribe a higher dose. Since opioids differ in potencies, MME is a value assigned to each opioid to represent its potency relative to morphine. This system led to doctors abruptly lowering the drug doses of patients on more than 90 MME, and insurers and pharmacies have used this as a maximum dose that they will cover or fill. Abruptly lowering doses can lead to unpleasant withdrawal symptoms like cramps, nausea, shaking and sweating.
The CDC is currently reviewing the effects of the guidelines and plans to publish updates as more evidence is available. While the guidelines have been a valiant effort to help many who are affected by opioid addiction, some patients who require opioids for pain management have been harmed. This CDC acknowledgment is a step in the right direction for those who suffer from chronic pain.
Dowell, Deborah. “CDC Guideline for Prescribing Opioids for Chronic Pain.” March 18, 2016. Accessed May 15, 2019.
Dowell, Deborah. “No Shortcuts to Safer Opioid Prescribing.” April 24, 2019. Accessed May 15, 2019.
IQVIA Institute Report. “Medicine Use and Spending in the U.S.” April 19, 2018. Accessed May 15, 2019.
Kroenke, Kurt. “Challenges with Implementing the Centers for Disease Control and Prevention Opioid Guideline: A Consensus Panel Report.” January 25, 2019. Accessed May 15, 2019.
Wolters Kluwer. “Morphine Equivalent Dosing.” Accessed May 15, 2019.