Tag Archives: CDC-Guidelines

CDC Checklist for Prescribing Opioids for Chronic Pain

CDC Checklist for Prescribing Opioids for Chronic Pain.pdf – from https://www.cdc.gov/drugoverdose/pdf/pdo_checklist-a.pdf

Below is the “official” checklist from the CDC for opioid therapy.

Nowhere does it say that doctors cannot prescribe opioid doses above 90MME, and if your doctor is telling you this, they are misinformed.

High opioid doses only require more caution and more documentation, which should already be the case due to the complexity of our care.   Continue reading

The Dangers of Guidelines & Recommendations

Guidelines are wonderful. Guidelines are dangerous – KevinMD.com – ROBERT CENTOR, MD | July 2017

Over the past decade, I have thought often about the benefits and the problems of clinical guidelines. The first concept that attracted my attention was reading about conflicting guidelines.  

Given the same data, different guideline committees would have significantly different recommendations.  At the least, this problem raises questions about guideline validity.

It makes clear that committee perspective could influence recommendations.  

This is exactly what happened when the CDC opioid prescribing guidelines were ghost written by addiction specialists from PROP.   Continue reading

Updated Opioid Guidelines for State Medical Boards 

Updated Opioid Guidelines Released for State Medical Boards – June 23, 2017 – By Kelly Rehan

“Guidelines emphasize individual treatment as opposed to rigid standards.”

The Federation of State Medical Boards (FSMB) released updated guidelines for using opioid analgesics to manage chronic, non-cancer pain. 

The updated document, which stresses safety through an individualized treatment approach, aligns with recent opioid advisories from the Centers for Disease Control and Prevention (CDC) and the US Food and Drug Administration (FDA).   Continue reading

Will Limits on Opioid Rx Duration Prevent Addiction?

Will Strict Limits on Opioid Prescription Duration Prevent Addiction? Advocating for Evidence-Based Policymaking: Substance Abuse:  , MD, MPH,  , MD, MPH &  , MD, MSc –  Jun 2017

Quick answer: NO!

In 2016, the Centers for Disease Control and Prevention (CDC) issued the first national guideline in the United States regarding opioid prescribing for pain.

The guideline included the recommendation that patients treated for acute pain should receive opioids for no longer than 7 days, prompting at least five states to implement laws requiring prescribers not to exceed this threshold when providing initial opioid supplies.

The rapid conversion of this guideline into policy appears to reflect an underlying assumption that limiting initial opioid supplies will reduce opioid consumption, and thus addiction.   Continue reading

CDC Guidelines Could Cause Problems for VA Patients

CDC Opioid Guidelines Could Cause Problems for VA Patients, Clinicians : U.S. Medicine By Annette M. Boyle – February 2016

Even though this is from a few years ago, it’s still valid in 2017.

Congress Is Forcing VA to Comply With ‘Voluntary’ Document

VA clinicians and their patients might find themselves in a difficult position related to proposed opioid prescribing guidelines from the national Centers for Disease Control and Prevention (CDC).

The CDC did a limited initial release of the guidelines in September with a two-day comment period and was immediately criticized for placing greater emphasis on reducing opioid abuse than relieving pain.
Continue reading

Tragedy of Unrelieved Pain and Suffering

Back to the Future—the Tragedy of Unrelieved Pain and Suffering – PAINS – Pain Action Alliance to Implement a National Strategy –  PAINS Project | Jun 15, 2017 |by Richard Payne, MD, Medical Director, PAINS Project

As a young doctor I attended a conference at MD Anderson Cancer Center titled “Treating Pain in a Drug Oriented Society.”

One of the conference keynote speakers, Dr. Kathleen Foley, called for the “decriminalization” of cancer pain, noting that (even back then) the American Medical Association,

  • the American Pain Society,
  • the American College of Physicians and
  • the World Health Organization

recognized that opioid pharmacotherapy was the mainstay of treatment for patients with cancer experiencing moderate to severe pain.  Continue reading

Opioid Rx Limits Will Not Prevent Addiction

Will Strict Limits on Opioid Prescription Duration Prevent Addiction? Advocating for Evidence-Based Policymaking – Mallika L. Mundkur , MD, MPH, Adam J. Gordon , MD, MPH & Stefan G. Kertesz , MD, MSc – June 20, 2017

In 2016, the Centers for Disease Control and Prevention (CDC) issued the first national guideline in the United States regarding opioid prescribing for pain.

The guideline included the recommendation that patients treated for acute pain should receive opioids for no longer than 7 days, prompting at least five states to implement laws requiring prescribers not to exceed this threshold when providing initial opioid supplies.

The rapid conversion of this guideline into policy appears to reflect an underlying assumption that limiting initial opioid supplies will reduce opioid consumption, and thus addiction.   Continue reading

Will Pill Control “Fix” Our Problem?

Here is a video of Dr. Kertesz’ criticism of how the CDC guidelines have been turned into regulations in various health care settings:

Will Pill Control “Fix” Our Problem?: The Allure of Simple Solutions

Sound medical decision-making and
how propaganda is hurting otherwise stable patients

Three points:

  1. The CDC guideline was a serious response to a serious problem
  2. Emerging practices don’t respect it and people are being hurt
  3. How did we get here? Continue reading

Opioids, Evidence Based Medicine, and Public Policy

Opioids, Evidence Based Medicine, and Public Policy; The Art of Creating an Unnecessary Public Health Crisis – National Pain Report – by David Nagel, MD – May 25, 2017

Dr. Nagel demonstrates how low-quality evidence, like that used by the CDC for their guidelines, is normally not used clinically.

He compares how such poor evidence is handled in the case of the prostate-specific antigen (PSA) test (rejected) versus the CDC guidelines (recommended).

A few days ago I met with my doctor for my annual physical

We talked a great deal about the utility of the prostate specific antigen (PSA) test which has been used for a few decades to predict and, hopefully, prevent prostate cancer.  It came as a bit of a surprise to me that this widely touted test was no longer recommended.   Continue reading

Opioid crisis: Pain patients pushed to the brink

Opioid crisis: Pain patients pushed to the brink; Overdose prevention efforts have had unintended — and dire — consequences By Markian Hawryluk, The Bulletin, @markianhawryluk – Jun 5, 2017

Three weeks after her last appointment, Sonja Mae Jonsson got a call from her doctor’s office in Waldport, telling her she needed to come in. Her urine drug screen had tested positive for a drug she hadn’t been prescribed.

The doctor would no longer prescribe her any pain medication.

Linda Jonsson, a registered nurse, had taken over her daughter’s care after a traumatic brain injury when she was 32, and carefully monitored her daughter’s medications. She pleaded with the clinic they had made a mistake.

Without the pain medications, they would be condemning her daughter to a life of pain.   Continue reading