Secretive guidelines for opioid prescribing from CDC

CDC: Opioids Not ‘Preferred’ Treatment for Chronic Pain — Pain News Network

This sudden, unusual, and secretive move by the CDC is unprecedented.

New draft guidelines by the Centers for Disease Control and Prevention (CDC) would – if adopted — sharply reduce the prescribing of opioids for both chronic and acute pain in the U.S.

The proposed guidelines may also trigger a turf battle between the CDC and the Food and Drug Administration over which agency has primary responsibility for the safe prescribing of medication. 

In an unusual online “webinar” held by the CDC, the agency today unveiled a dozen draft guidelines for physicians to follow when prescribing opioids. The first recommends “non-pharmacological therapy” as the “preferred” treatment for chronic non-cancer pain, and states that opioids should only be prescribed if the benefits of reducing pain outweigh the risk of addiction and overdose.

Other guidelines recommend urine drug testing of patients both before and during opioid use, and that smaller doses and quantities be prescribed. Only “three or fewer days” supply of opioids is recommended for most types of acute pain. The guidelines also recommend that benzodiazepines not be prescribed concurrently with opioids.

The CDC is proposing that it is better to put millions to a slow and torturous death rather than risk overdose. You might as well plan a genocide for true pain patients.” — Reader comment

Pain patients listening to the webinar expressed alarm over some of the recommendations.

“I would caution the CDC that putting these dosage limits in here would cause problems for patients,” said Marjorie. “These recommendations have severe ramifications.”

The CDC took comments about the guidelines during the webinar, but refused to answer any questions about them. The agency said it would finalize its guidelines in early November to submit to the Department of Health and Human Services, with the goal of publishing them in January, 2016.

The CDC’s guidelines were NOT publicly available before the webinar, there was little advance notice about it, and there were numerous technical problems for some people who tried to participate online

While the CDC recorded the webinar, it is NOT making it available for people to watch or listen to afterwards. The draft guidelines, outlined below, will also NOT be available on the CDC’s website.

CDC Draft Guidelines for Opioid Prescribing:

  1. Non-pharmacological therapy and non-opioid pharmacological therapy are preferred for chronic pain. Providers should only consider adding opioid therapy if expected benefits for both pain and function are anticipated to outweigh risks.
  2. Before starting long term opioid therapy, providers should establish treatment goals with all patients, including realistic goals for pain and function. Providers should continue opioid therapy only if there is clinically meaningful improvement in pain and function that outweighs risks to patient safety.
  3. Before starting and periodically during opioid therapy, providers should discuss with patients risks and realistic benefits of opioid therapy and patient and provider responsibilities for managing therapy.
  4. When starting opioid therapy, providers should prescribe short-acting opioids instead of extended-release/long acting opioids.
  5. When opioids are started, providers should prescribe the lowest possible effective dosage. Providers should implement additional precautions when increasing dosage to 50 or greater milligrams per day in morphine equivalents and should avoid increasing dosages to 90 or greater milligrams per day in morphine equivalents.
  6. Long-term opioid use often begins with treatment of acute pain. When opioids are used for acute pain, providers should prescribe the lowest effective dose of short-acting opioids and should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. Three or fewer days will usually be sufficient for non-traumatic pain not related to major surgery.
  7. Providers should evaluate patients within 1 to 4 weeks of starting long-term opioid therapy or of dose escalation to assess benefits and harms of continued opioid therapy. Providers should evaluate patients receiving long-term opioid therapy every 3 months or more frequently for benefits and harms of continued opioid therapy. If benefits do not outweigh harms of continued opioid therapy, providers should work with patients to reduce opioid dosage and to discontinue opioids when possible.
  8. Before starting and periodically during continuation of opioid therapy, providers should evaluate risk factors for opioid-related harms. Providers should incorporate into the management plan strategies to mitigate risk, including considering offering naloxone when factors that increase risk for opioid-related harms are present.
  9. Providers should review the patient’s history of controlled substance prescriptions using state Prescription Drug Monitoring Program data to determine whether the patient is receiving excessive opioid dosages or dangerous combinations that put him/her at high risk for overdose. Providers should review Prescription Monitoring Program data when starting opioid therapy and periodically during long-term opioid therapy (ranging from every prescription to every 3 months).
  10. Providers should use urine drug testing before starting opioids for chronic pain and consider urine drug testing at least annually for all patients on long-term opioid therapy to assess for prescribed medications as well as other controlled substances and illicit drugs.
  11. Providers should avoid prescribing of opioid pain medication and benzodiazepines concurrently whenever possible.
  12. Providers should offer or arrange evidence-based treatment (usually opioid agonist treatment in combination with behavioral therapies) for patients with opioid use disorder.

 

The CDC said the guidelines were developed after a series of meetings with a “core expert group” and “independent peer reviewers” that the agency did not identify by name.

This lack of openness indicates they do not want us to know who they are taking their advice from.

CDC officials have long been critical of opioid prescribing practices and have repeatedly cited a study that claims over 16,000 Americans are killed annual by overdoses linked to pain medications.

Many, or even most, of these 16,000 deaths were caused by mixing prescription opioids with other drugs, like tranquilizers or alcohol, so they aren’t JUST from opioids.

“If the evidence of their guidelines are of the quality of their research on opioid overdoses, then we are in big trouble. They claim they will be using evidenced based material in forming these guidelines, however they have never shown any desire to correctly evaluate evidence for its strength and value,” said Janice Reynolds, a retired nurse and longtime activist in the pain community.

“I am sure their information came from addiction disease doctors who have an arrogance based model of practice and many don’t care about pain management.  Much of their information comes from PROP.”

PROP (Physicians for Responsible Opioid Prescribing) is a controversial organization that has lobbied Congress and criticized the FDA for not doing more to limit access to opioids. A link to PROP literature recommending “cautious, evidence-based opioid prescribing” can be found — unedited — on the CDC’s website.

This shows the underhanded nature of this proposal. The PROP physicians are all “interventional Pain Specialists” who benefit greatly from dangerous procedures, like epidurals, that have NOT been proven effective.

The CDC knows nothing about pain management and possibly less about pharmacology, so why should anyone listen to them?” asked Reynolds. “Their complaints against opioids only increases the misery of people with pain and does little to prevent deaths as most people with an addiction to prescription medications obtain their meds not by legitimate prescriptions.”

According to the National Institutes of Health, only about 5% of patients taking opioids as directed for a year end up with an addiction problem.

The CDC does not normally get involved in setting guidelines for prescription drugs, a responsibility that falls on the FDA – which regulates drugs and determines which ones can be used to treat medical conditions.

A spokesman for the FDA who handles opioid issues told Pain New Network he was unaware the CDC was drafting its own opioid guidelines.  

The CDC has a webpage for these opioid treatment guidelines that does NOT contain the guidelines, but only assertions about addiction and overdoses.

It is truly puzzling why the CDC would suddenly begin such secretive proceedings and interfering in areas with which it has no expertise or experience.

 

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17 thoughts on “Secretive guidelines for opioid prescribing from CDC

  1. painkills2

    If the DEA drew up guidelines, they would look very similar. Who am I kidding, they would look exactly the same. I don’t know when the CDC became a part of the DEA, but when you add PFROP’s influence to that of the DEA’s, you get stuff like this. There’s also probably some political power struggle going on between federal agencies — when is there not?

    Seems to me that the CDC would need specific funding to work on a project like this. How many CDC employees are working on it? How long has it been going on? Who authorized the project’s funding? Does the CDC have congressional authority to poke their nose into this issue?

    Everybody’s telling doctors how to do their jobs — State Boards, the government, insurance companies, law enforcement. You’d think doctors would get tired of being treated like children. Certainly patients are tired of it.

    Liked by 2 people

    Reply
  2. Jeff Hutchison

    I am a chronic pain sufferer. All of the normal drugs have failed in my treatment. I depend on opiates to have a normal function in life and contribute to society. You need to have people like myself included in the groups that make the final decision. Having people that are not experiencing chronic pain make the decisions is not correct. Feel free to contact me as I would love to be involved.

    Liked by 4 people

    Reply
    1. kimmeekmiller

      Jeff Hutchison,

      I am writing my congressman, senators and the Whitehouse EVERY week until they stop threatening to take our meds away or I am physically unable to because I am dead!

      I write that I am a chronic pain patient and need these meds to have any kind of life. I ask that the put no more restrictions on opioids because keeping me from getting pain meds will NEVER stop a drug addict from getting drugs.

      It may be futile, but if WE ALL DO IT, who knows?

      Liked by 3 people

      Reply
  3. Payne Hertz

    Is the CDC acting outside its legislative remit? It certainly seems so. Their job is to study diseases. Since when do cars, guns, drugs and other inanimate objects controlled by humans qualify as diseases?

    It is interesting that Congress banned the CDC from studying guns due to the CDC openly promoting a gun control agenda and doing research that some people in Congress and the NRA considered one-sided to support it. Now it seems they are stepping outside their purview to do one-sided, sloppy research in favor of drug prohibition which completely ignores the positive aspects of opioid use while exaggerating its harms. It also conveniently and completely ignores most of the other harms associated with medical treatment, such as the massive “epidemic” of deaths and injuries due to medical errors.

    It the NRA can get Congress to ban what it considers to be biased research I wonder if we might do the same if we were organized. It would be nice to get some serious money being invested into researching alternatives to opioids rather than finding reasons to deny people access to the only meds that work for many people in pain.

    Liked by 3 people

    Reply
    1. painkills2

      Do you think that pain patients can become as scary as gun lovers? Do you want the public to become as afraid of pain patients as they are of NRA members?

      I’m not sure I could become a bully, even if the issue was serious enough to mean life or death for me.

      Like

      Reply
      1. Payne Hertz

        Our ruling class seems as terrified of citizens being able to treat their own pain as they are of them being able to defend themselves. So we have the hacks at the CDC using questionable “science” that considers only the negative impacts of things like opiate drugs and guns, and never whether there are positive aspects to either such as the prevention of crime or the relief of pain and prevention of suicide. Funny they consider the suicide issue in denouncing guns but never in the question of opiate medicines and their use and abuse.

        Regardless of what you think of the NRA or its often questionable tactics, government agencies should remain politically neutral on matters of science and operate within the bounds of their legislative remit, The CDC clearly does not do so. So it is good that the NRA called them on this but we unfortunately do not have that kind of power. I’m not sure this qualifies as “bullying.”

        As for what the public has been brainwashed into fearing the psychopaths at the top of our food chain are responsible for infinitely more mayhem over the last few decades than “gun lovers” at their worst. Our heavily armed society may be the the only thing standing between us and a full blown fascist police state, which is definitely the direction our country is moving in.

        Liked by 1 person

        Reply
  4. Dave

    Some of you may not be aware that the head of the CDC was the former NYC Health Commissioner- and served during a time when the alleged opioid epidemic hit NYC. I believe he took a lot of flak for being asleep at the switch. Perhaps now he is trying to make amends, so to speak so that after he leaves the CDC he will be in good standing to return to NYC with a good job in the health care industry.
    But what is more interesting to me is why hawnt Secretary Burwell or someone in Obamas Cabinet prevented the schism in the DHHS on opioids. So either Burwell, Obama and others should have tried to have a united front on the issues rather then convulse society on opioids.

    Liked by 1 person

    Reply
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  7. Sara Batchelder

    Addiction is addiction. Pain management is pain management. Two separate diseases. They should be treated as such. The fact that people are switching to heroin from opioid prescriptions shows that they are slipping through the cracks of the FDA/DEA’s new system of restricting prescriptions for everyone. I would rather those people were still on opioids prescribed by a doc. They may still be alive today. The fact that the gov’t restricted all of these drugs without increasing addiction treatment shows that there is something else at work here, not concern for sick people. Where do we go to join with other pain patients? We need to overturn these gov’t decisions before we lose more pain patients to suicide and severe pain. I am ready to fight, but of course, as pain patients, we are extremely easy for the gov’t to take advantage of. Where is our lobby????? We don’t have one, because most of us have lost our jobs and can barely function.

    Liked by 3 people

    Reply
  8. leejcaroll

    If I am reading them correctly, they are leaving it up to the doctor. Some of the issues are problematic such as docs prescribing large amounts of pills for acute pain, such as a sprain (a friend told me she received oxy for her sprain, not appropriate.). I just see suggestions that make sense (absent coming in every 3 months. Some patients can very well manage their meds and do not need to be seen again and again.)
    (and please don;t reply that i don;t understand. I have had chronic pain since 1979 trigeminal neuralgia and been on various narcotics for almost all of the time (absent when a surgery would work, or help for unfortunately only short periods of time

    Liked by 1 person

    Reply
  9. Dennis Gannon

    My life will never be anything near normal again due to the amount of severe suicidal torturous pain I endure on a moment to moment basis. I have A-Typical Trigeminal Neuralgia, Occipital Neuralgia, severe headaches & migraines, severe tmj and all the ailments attached to them. There is no cure but there are serious brain surgeries that could possibly help or make things much worse. So I am forced to take extended release opioids to ease the pain enough to keep me from being suicidal. Trigeminal Neuralgia is unfortunately called the suicide disease because nearly 1/3 of those with it end up committing suicidal to relieve themselves from the constant intense facial and head pain. I must live my life as still as possible in order to not trigger more pain. I am thankful for the beautiful godsend of a plant called the poppy plant. This plant has been utilized since the dawn of humanity to relieve pain and it actual was called ” God’s Own Medicine ” some time ago. To keep humans from this plant, that have every human right to receive this plant is an atrocity and will result in genocide via suicide by those who live with such pain. Nobody asked for these pains and god knows nobody wants to kill themselves to escape those pains. So do yourself a favor and gain some compassion for your fellow humans. Research trigeminal neuralgia, a-typical trigeminal neuralgia, occipital neuralgia and similar neuralgias, so you can gain some perspective.

    Dennis Gannon

    Liked by 3 people

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  11. Paula Mckinney

    This makes no sense! How can CDC do this! What about cronic pain! We suffer enormous amounts of pain, some meds help us function, with hour them we can’t get out of beb.

    Liked by 2 people

    Reply
    1. Zyp Czyk Post author

      It’s pretty darn outrageous and has been initiated by PROP – the same organization that pushed this agenda in 2012 but was turned down by FDA. I guess that’s why they’re trying to push it through the CDC this time.

      To see other posts on PROP and their anti-opiate agenda, use this search.

      Like

      Reply
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