CDC Guideline Harms Pain Patients

CDC Guideline Harms Pain Patients, Panel Says – by Judy George, Contributing Writer, MedPage Today – March 11, 2019

The CDC’s 2016 opioid guideline is being implemented in ways that harm chronic pain patients, a panel of physicians said here.

I agree that the problem isn’t with the guidelines themselves.  They were just

1) suggestions,
2) for primary care providers and
3) first-time opioid prescriptions.

The problem is that they have been weaponized by anti-opioid crusaders to make laws and rules that force opioid tapers even when not medically indicated. 

At the 2019 American Academy of Pain Medicine (AAPM) meeting, a consensus panel convened by the AAPM Foundation highlighted problems with how the CDC guideline has been applied, raising concerns that it has been interpreted as a regulation and used to impose rigid dose and duration limits.

“A clinician’s ability to make decisions has been severely interrupted,” said Charles Argoff, MD, president of the AAPM Foundation and consensus panel member, in an interview with MedPage Today.

“The recommendations of the guideline itself have not been sufficiently explored with respect to their impact on practicing medicine in the real world,” Argoff continued.

“And in many ways, that has led to harm.”

Arbitrary prescribing limits do not benefit all patients, and pain cannot be managed with a one-size-fits-all approach, panelists agreed. But equally important are wider ramifications of the CDC document, several members pointed out.

The CDC guideline also failed to appreciate the importance of involving patients in the decision to taper or discontinue opioids.

Through a consensus report — published in Pain Medicine — the panel aimed to reach policymakers and institutions that influence guideline implementation including regulatory agencies, legislators, public and private payers, and healthcare systems.

See Challenges with Implementing the Centers for Disease Control and Prevention Opioid Guideline

The report also proposed steps to address unintended consequences of the guideline (see CDC Opioid Guideline: Unintentional Consequences?), including:

• Educating clinicians about the risks of abruptly discontinuing opioids without focused care
• Not misinterpreting the guideline by insisting opioids be stopped or reduced when they are warranted
• Supporting sufficient reimbursement and coverage for comprehensive pain management services, including psychological and physical treatments

“A big issue is the role that insurance companies play in the way healthcare is delivered,” Argoff noted.

The CDC guideline came under fire from another group last week when 300 healthcare professionals, including three former White House drug policymakers, issued a public letter to the CDC saying the guideline is being used

1. by insurers to deny reimbursement and
2. by doctors to turn away patients.

The group, called Health Professionals for Patients in Pain, urged the agency to evaluate the guideline’s impact — including its reported effects on patient suicides and increased illicit opioid use — and to issue a “bold clarification” about what the guideline says and does not say, especially about tapering and stopping opioids.