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 mg 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 although 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 caused 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 which 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 and related stories.
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.