Issues With the CDC Guidelines

The Issues With the CDC Guidelines on Opioids for Chronic Pain, According to AAPM’s Director by Florence Chaverneff, Ph.D. September 26, 2016

This article is noteworthy because of where it appears (in a publication mostly dedicated to parroting the CDC’s ideas) and who is speaking (BobTwillman, president of the American Association of Pain Management)

In March 2016, the Centers for Disease Control and Prevention (CDC) released guidelines on prescribing opioids for the management of chronic pain. These guidelines, formulated in response to the ongoing opioid epidemic that has overcome the United States, have caused much controversy within the medical community

Dr Twillman started by expressing caution towards the numbers advanced by the CDC, regarding the opioid and chronic pain epidemics.  

For example, opioid overdose-related deaths were estimated to be stable from 2009 to 2013, at about 16000, but are now estimated to have increased to 19000. These numbers are based on “information that is a little bit suspect to begin with,” noted Dr Twillman, as they are gathered from death certificates which may be filled out by medical examiners or coroners.

In addition, heroin overdose-related deaths are included in the opioid overdose-related deaths figures.

This is the great absurdity of the current situation. Both heroin addicts and pain patients with legitimate prescriptions are counted as ONE category: opioid users.

PROP has pushed this interpretation on the American Public with its clever PROPaganda, which has been so successful that it has overcome reason in politics and even the science community.

Numbers regarding fentanyl-related deaths also include deaths resulting from illicit forms of the drug, which may have been manufactured in China and resemble a pill of hydrocodone, added Dr Twillman. “We really need to figure out how to report these numbers in a much better way,” he added.

“We not only have 1 complex problem, but 2: prescription drug overdose and abuse and chronic pain,” he added. “The policy-makers seem to think that we can apply a simple solution, and that creates a lot of adverse and unintended consequences.”

Dr Twillman extensively emphasized the fact that these CDC guidelines are expert-based and not evidence-based.

This is an interesting distinction.

In addition, most of these experts are strongly biased, as indicated by their affiliations to, for example, anti-opioid advocacy groups.

Previous guidelines on the “role of opioids in the treatment of chronic pain” published in September 2014 by the National Institutes of Health and based on literature review concluded

“What was particularly striking to the panel was the realization that there is insufficient evidence for every clinical decision that a provider needs to make regarding the use of opioids for chronic pain, leaving the provider to rely on his or her own clinical experience.”

Yet the CDC guidelines take away the input of our providers’ experience by substituting arbitrary dose limits and ineffective actions.

According to Dr Twillman, the target should be what the patient and their healthcare provider have decided between themselves as a reasonable goal to accomplish.

The biased nature of these guidelines is an issue, concluded Dr Twillman, “because [they are] formulated by the CDC, they are going to be accepted as gospel by many people.”

He added “Inevitably, these guidelines will be accepted as the standard of care in malpractice cases, and payers are going to use [them] to establish reimbursement plans.”

Many states in 2016 have already legislated some form of the CDC recommendations for acute pain treatment, for example, limiting the use of opioid from 3 to 10 days or the dose administered. Dr Twillman recommended physicians in the audience be aware of those state laws, as they will affect their practice.