Safe GC Coalition: Controversy Over New CDC Guidelines for Opioids

A recent article in The Lancet discussed the Centers for Disease Control and Prevention (CDC) proposed 12 new recommended guidelines for prescribing opioid painkillers that remove its previous recommended ceilings on doses for chronic pain patients and instead encourage doctors to use their best judgment. Those ceiling guidelines has been widely blamed for leading to harmful consequences for patients with chronic pain.

Federal officials have acknowledged their original guidance was often misapplied; it was supposed to serve as a roadmap for clinicians navigating tricky decisions around opioids and pain — not as a rigid set of rules. But the 2016 version was used as the basis for sweeping policy decisions, as lawmakers and health leaders struggled to contain the nation's overdose crisis. Many states adopted laws and regulations that set limits on prescribing, and health insurers also crafted policies to that effect. Doctors grew wary of giving opioids at all, which often led to sudden disruptions of treatment, resulting in physical and mental agony, and even a heightened risk of suicide as the restrictive climate around prescribing has persisted. This is why the CDC’s revised guidance is now under scrutiny. Some health care experts view the proposed changes as a promising step toward addressing the harms suffered by pain patients in the wake of the previous guidelines. And yet many others, including patients with chronic pain, argue that the guidance is still flawed — with the potential of being misinterpreted and misapplied.

The new proposed guidelines continue to advise against using opioids for pain when possible and to take a cautious approach when it's necessary, given the risks of opioid misuse and overdose. But there are some notable changes from the old guidance. The top recommendations often the takeaways for clinicians and policymakers no longer include specific limits on the dose and duration of an opioid prescription that a patient can take. Opioids have been used as a first-line therapy for many common acute pain conditions — among them, lower back pain, musculoskeletal injuries and pain related to minor surgeries. The guidelines also discourage using opioids for chronic pain, but acknowledges that opioid therapy can play a role in treatment, in particular if other approaches have been tried.

Some patients and clinicians maintain the updated version still falls short of fixing the problems chronic pain patients face because they lack balance when discussing decisions around starting and stopping opioid therapy, by focusing mostly on the harms of opioids, not the benefits when medically supervised, or the risks and harms of poorly managed pain.

The CDC guidelines continue to be a work in progress but cannot be held responsible for all the chaotic mistreatment of patients because doctors, policymakers, regulators and insurers all reacted in a way that went well beyond what the initial document called for. Hopefully the new guidance will lead to meaningful changes in the laws and policies that are in effect.

The Lancet is a weekly peer-reviewed general medical journal. It is among the world's oldest and best-known general medical journals. For more information please visit www.thelancet.com.

The Centers for Disease Control and Prevention (CDC) is a federal agency that conducts and supports health promotion, prevention and preparedness activities in the United States, with the goal of improving overall public health. To learn more about the CDC please visit www.cdc.gov.

The SAFE Glen Cove Coalition is conducting an opioid prevention awareness campaign entitled. “Keeping Glen Cove SAFE,” in order to educate and update the community regarding opioid use and its consequences. To learn more about the SAFE Glen Cove Coalition please follow us on www.facebook.com/safeglencovecoalition or visit SAFE’s website to learn more about the Opioid Epidemic at www.safeglencove.org.