Overdose Epidemic

How the CDC’s opioid prescribing guidance went astray

Kevin B. O'Reilly , Senior News Editor

What’s the news: Three authors of the Centers for Disease Control and Prevention’s (CDC) controversial 2016 guideline on opioid prescribing now say their advice has been misused in ways that can harm patients.

These misapplications “include inflexible application of recommended dosage and duration thresholds and policies that encourage hard limits and abrupt tapering of drug dosages, resulting in sudden opioid discontinuation or dismissal of patients from a physician’s practice,” wrote the CDC’s Deborah Dowell, MD, MPH, Tamara Haegerich, PhD, and Roger Chou, MD, in a New England Journal of Medicine essay, “No Shortcuts to Safer Opioid Prescribing.”

Why it matters for patients and physicians: Patrice A. Harris, MD, President-elect of the AMA and chair of the AMA Opioid Task Force, noted in response that the CDC guideline recommendations have been “wrongly treated as hard-and-fast rules, leaving physicians unable to offer the best care for their patients.”

The guideline authors’ essay “underscores that patients with acute or chronic pain can benefit from taking prescription opioid analgesics at doses that may be greater than the guidelines or thresholds” outlined by government agencies, payers, pharmacy chains, pharmacy benefit managers (PBMs) or other bodies, she added.

What’s next: The misapplication of the CDC guideline has been so broad, said Dr. Harris, “that it will be hard to undo the damage.” She said the AMA is calling for a “detailed regulatory review of formulary and benefit design by payers and PBMs to ensure that patients have affordable, timely access to medically appropriate treatment, pharmacologic and nonpharmacologic.”

The AMA also will work with the CDC to help ensure that patients get “multidisciplinary, multimodal pain care based on medical science and effective clinical practice,” Dr. Harris said. The U.S. Agency for Healthcare Research and Quality, with CDC funding, is conducting systematic reviews to gauge the effectiveness of various treatments for acute and chronic pain.