Patients and providers say changes to CDC opioid guideline inadequate

Proposed changes to the CDC’s opioid prescribing guideline are inadequate and will not undo the damage caused to patients and the practice of pain management, according to a large new survey by Pain News Network, an independent, non-profit news organization. Most survey respondents (63%) want the guideline revoked, not revised.

The U.S. Centers for Disease Control and Prevention released a long-awaited draft revision of its 2016 guideline in February, giving healthcare providers more flexibility in how they manage pain with opioids.   Although voluntary, the original guideline was misapplied as a rigid “standard of care” by many states, insurers, doctors and law enforcement, causing millions of patients to be taken off opioids or tapered to lower doses.

Although the revised guideline states that “opioids can be essential medications for the management of pain” and encourages doctors to use their own best judgement when prescribing them, many patients and providers believe the changes don’t go far enough and may even make the crisis in pain care worse.

“Appreciate the effort, but too little too late. These revisions are like trying to prevent disaster by course correcting the Titanic after it hit the iceberg,” one patient said. “The revisions offer no protection against overzealous DEA interference and prosecution, and are meaningless in court. Until the draconian laws spawned by the guidelines are changed, things will only continue to get worse.”

“In 45 years of treating patients with pain, I have never seen it so difficult for patients to have their reports of pain taken seriously and get access to pain treatment,” said a doctor. “Patients often feel treated like addicts, and have had many professionals and family members supporting that erroneous and stigmatizing label.”

Over 2,500 patients, providers and caregivers in the U.S. responded to the online survey. Over half the patients (57%) rated the quality of their pain care as poor or very poor.  Other key findings:

• 78% Believe 2016 CDC guideline made the opioid crisis worse
• 93% Believe the guideline worsened the quality of pain care
• 84% Believe CDC should not have guidelines for opioid prescribing and pain management
• 95% Believe CDC needs to do a better job tracking the impact of its guideline on patients
• 96% Don’t trust CDC to handle the guideline revision in an unbiased and scientific manner
• 39% Believe the revised guideline is an improvement over the 2016 guideline.

Patients and providers are also worried the revised guideline could lead to lower and ineffective doses of opioids being prescribed. The 2016 guideline strongly encouraged doctors not to write prescriptions that exceed doses of 90 morphine milligram equivalents (MME) per day. The 90 MME limit has been dropped from the revised draft, but doctors are still urged to be cautious about going over 50 MME due to the risk of addiction and overdose. 

Over 97% of survey respondents are concerned that 50 MME will be seen as the new hard limit for opioid doses.

“The CDC is assuming that, by reducing the misapplied 90 MME standard to 50 MME, it will reduce misapplication of the standard. Faulty logic. It will, in fact, make it even harder for pain patients to be prescribed more than 50 MME, and the result will be more people in more pain and an increase in pain patient suicides,” a patient said.

Although opioid prescribing in the U.S. has fallen to levels not seen in 20 years, fatal overdoses have reached record levels. The CDC estimates there were over 105,000 drug deaths in 2021, most of them involving illicit fentanyl and other street drugs.  The agency is expected to release a final version of the revised opioid guideline late this year.

The Pain News Network survey was conducted online from March 5 to April 11. The vast majority of respondents (94%) identified themselves as patients with either chronic or short-term acute pain.  To see the complete survey results, click here.