HHS split on CDC opioid prescription guidelines

HHS split on CDC opioid prescription guidelines | Peter Pitts

A panel set up to coordinate pain research across the federal government is blasting a CDC proposal to rein in opioid prescribing set for release next month.

Members of the NIH’s Interagency Pain Research Coordinating Committee, which was created by Obamacare and includes the FDA, AHRQ and the Department of Veterans Affairs, announced at a meeting Thursday that they plan to file a formal objection to the CDC prescribing guidelines.

These guidelines are being rejected by almost all other government agencies involved in medical care of pain.  

The level of evidence cited to support the guidelines, which are non-binding on physicians, “is low to very low and that’s a problem,” said Sharon Hertz, FDA’s director of the Division of Anesthesia, Analgesia and Addiction Products.

AHRQ health scientist Richard Ricciardi called the recommendations “ridiculous” and “an embarrassment to the government.”

The dissension within HHS adds to a chorus of complaints from both the pain community and major medical groups including the American Medical Association and the American Cancer Society Cancer Action Network, which have criticized CDC’s selection of experts and the limited opportunity for public input on the guidelines

Several committee members were frustrated that the response to the opioid epidemic appeared to trump a broader effort underway to develop an integrated strategy to combat pain and could in fact hinder it by limiting access to certain necessary drugs.

We have both a pain and an opioid use disorder problem. Both are important. Both are serious,” said Richard Frank, HHS assistant secretary for planning and evaluation.

CDC did not respond to a request for comment.

#The CDC has said little about this backhanded maneuver, which was spearheaded by a special interest group: PROP.

CDC policy official Sara Patterson told the interagency group by conference call that the guidelines’ three main goals are

  1. to have providers prescribe non-opioid options for pain when possible;
  2. to use the lowest effective dose when opioids are necessary, and
  3. to actively evaluate the risk and potential harms of ongoing treatment.

Each category has a number of specific guidelines, and many are characterized as a “strong recommendation” with “low evidence” or “very low evidence” because of the lack of randomized control trials.

AHRQ found scant evidence that opioids control chronic pain and that long-term use had serious risks.  

#This is the only realistic assessment, which confronts the truth that there is simply no evidence upon which to base these guidelines.

 

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