CDC Responds to Instances of Misapplication of Opioid Guidelines

April 26, 2019

Physicians have been misapplying the CDC’s 2016 opioid prescribing guideline, causing challenges for some pain patients, according to a new commentary.

Some instances of misuse of the CDC’s opioid reduction guidelines have increased risks to patient health and safety, according to a commentary in the New England Journal of Medicine. The misapplication of the guidelines is causing difficulties for some patients with severe pain. The CDC has responded.

The authors of the “CDC Guideline for Prescribing Opioids for Chronic Pain” said in a New England Journal of Medicine commentary that misapplication of opioid guidelines can risk patient health and safety. 

In a statement from the CDC, it says it “commends efforts by healthcare providers and systems, quality improvement organizations, payers, and states to improve opioid prescribing and reduce opioid misuse and overdose,” some policies and practices are not consistent with the recommendations. 

The guideline is intended for primary care clinicians treating chronic pain for patients 18 years and older, but physicians have been limiting or cutting off opioid scripts for patients in active cancer treatment, those experiencing acute sickle cell crises, or even those experiencing postsurgical pain, the CDC says.

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“The guideline does not support abrupt tapering or sudden discontinuation of opioids. These practices can result in severe opioid withdrawal symptoms including pain and psychological distress, and some patients might seek other sources of opioids,” CDC says. “In addition, policies that mandate hard limits conflict with the guideline’s emphasis on individualized assessment of the benefits and risks of opioids given the specific circumstances and unique needs of each patient.”

The intent of the guideline was “to ensure prescribers were cognizant of the risks with doses above the recommended thresholds and only exceeded them in cases they deemed appropriate,” Michael Ganio, PharmD, director of Pharmacy Practice and Quality at ASHP, tells Drug Topics. “The guidelines were not meant to be applied to patients receiving cancer treatment, sickle cell crisis management, or postsurgical pain patients. The guidelines did not suggest cutting off opioids already prescribed at higher doses.”

The guideline’s limits on milligram morphine equivalents (MME) per day have been used in state legislation or payer policies as hard maximum limits, resulting in rapid tapering down of doses in some patients or ineffective dosing in others, Ganio says.

“The clarification of the guidelines can help pharmacists work with patients and prescribers to ensure that the most effective and safe doses of opioids are used to treat pain. Pharmacists can also work collaboratively to ensure multimodal treatments are used to address pain, and to reduce risk factors and concomitant medications associated with opioid overdose,” Ganio says.

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“The guideline was developed to ensure that primary care clinicians work with their patients to consider all safe and effective treatment options for pain management. CDC encourages clinicians to continue to use their clinical judgment, base treatment on what they know about their patients, maximize use of safe and effective non-opioid treatments, and consider the use of opioids only if their benefits are likely to outweigh their risks,” the agency  says.

ASHP maintains an Opioid Management Resource Center on its website with information that pharmacists can use in their practice. The resource center includes links to online education in the form of webinars and presentations for safe prescribing of opioids.