CDC’s Proposed Opioid Guideline Revision Is aMarked Improvement–Alas in Most States Patients/Doctors Will Remain Stuck with the Old One
pa href=https://www.cato.org/people/jeffrey-singer hreflang=undJeffrey A. Singer/a
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pspanspanspanResponding to sharp criticism from academic and clinical pain and addiction specialists, the American Medical Association, the American Society of Addiction Medicine, and patient advocacy groups, the Centers for Disease Control and Prevention plans to revise the a href=https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm2016 Guideline for Prescribing Opioids for Chronic Pain—United States./a On February 9, 2022, it a href=https://www.medpagetoday.com/painmanagement/opioids/97133?xid=nl_mpt_DHE_2022-02-11amp;eun=g1183284d0ramp;utm_source=Sailthruamp;utm_medium=emailamp;utm_campaign=Daily%20Headlines%20Top%20Cat%20HeC%20%202022-02-11amp;utm_term=NL_Daily_DHE_dual-gmail-definitionreleased/a anbsp;a href=https://www.federalregister.gov/documents/2022/02/10/2022-02802/proposed-2022-cdc-clinical-practice-guideline-for-prescribing-opioidsdraft proposal/a and is seeking comments from interested parties over the next 60nbsp;days. It intends to release an updated set of guidelines by the end of this year./span/span/span/p
pspanspanspanAs Josh Bloom, Director of Pharmaceutical and Chemical Science at the American Council on Science and Health explains a href=https://www.acsh.org/news/2022/02/10/panic-propville-cdc-trashes-2016-opioid-advice-pain-patients-will-be-treated-humans-16125here/a, the proposal is anbsp;step in the right direction. The new guidelines emphasize to policymakers that they should not be interpreted as hard and fast rules, but rather general suggestions, “intended to be flexible to enable person‐centered decision‐making, taking into account an individual’s expected health outcomes and well‐being,” and that they are not “a replacement for clinical judgment or individualized, person‐centered care…Intended to be applied as inflexible standards of care across patients, and/or patient populations by healthcare professionals, health systems, pharmacies, third‐party payers, or governmental jurisdictions or to lead to the rapid tapering or discontinuation of opioids for patients.” /span/span/span/p
pspanspanspanUnfortunately, as Inbsp;explain a href=https://www.cato.org/blog/lawmakers-really-want-follow-science-they-will-repeal-codified-opioid-guidelineshere/a, and in testimony before the Arizona Senate Health and Human Services Committee a href=https://www.cato.org/multimedia/media-highlights-tv/jeffrey-singer-testifies-senate-bill-1162-opioid-prescriptionshere/a, the guidelines still cling to anbsp;morphine milligram equivalent conversion table that is pharmacologically unsound and is based on 60‐year‐old single‐dose clinical trials largely based on subjective pain scores that have been cobbled together over the years and accepted as conventional wisdom./span/span/span/p
pspanspanspanAlso unfortunate is that a href=https://ballotpedia.org/Opioid_prescription_limits_and_policies_by_state36 states/a have enacted laws, based on the 2016 CDC guidelines, that impose hard limits on opioid prescribing. Many of those states enshrined the morphine milligram equivalent conversion tables in statute. Therefore, while it is laudable that the CDC is revising its guidelines to stress individualized, nuanced treatment of patients in pain, in much of the country patients and doctors are still stuck with the discredited and soon‐to‐be‐discarded 2016 guidelines. /span/span/span/p
pspanspanspanState lawmakers should learn from their mistake and not repeat it. They should repeal the hard statutory limits and resist the temptation to stultify clinical medicine by dictating through law how health care practitioners treat patients with pain./span/span/span/p