March 1, 2022
In 2016, the Centers for Disease Control and Prevention (CDC) released the CDC Guideline for Prescribing Opioids for Chronic Pain (from here referred to as “the Guideline”). The Guideline was intended to provide recommendations for primary care doctors for the prescribing of opioids for chronic pain. It aimed to ensure people with pain could have access to safe and effective treatment while reducing risk of the misuse and overdose.
Since its release, however, the 2016 Guideline has been widely misapplied. Policies focused narrowly on decreasing dose and duration and broadly limiting opioid prescriptions have been enacted across the country and adopted by pharmacies, payers, and providers, creating massive new barriers to pain treatment. People with pain have been unable to access needed medications, tapered forcibly and/or abruptly to lower doses or off their medications entirely, or abandoned by their doctors and unable to access healthcare altogether. The Guideline has resulted in devastating consequences for people with pain.
Recognizing these harms, the CDC issued a clarification warning against such policies and misapplications in April 2019. These harms were also addressed in safety alerts from the Food and Drug Administration (FDA) and the Department of Health and Human Services (PDF) and in the Pain Management Best Practices Inter-Agency Task Force Final Report (PDF).
Even so, to this day the Guideline continues to be misapplied by insurance companies, state legislatures, Medicaid payers, state health departments, medical boards, pharmacy benefit managers, pharmacies, quality improvement organizations, hospital systems, individual providers, and law enforcement. We continue to hear from desperate patients and their family members every week.
In 2019, the CDC announced their intent to re-evaluate and update the Guideline. See additional information about their plan and process. During the updating process, there were multiple opportunities for public input; NCIL weighed in at every opportunity. In addition to urging a transparent and inclusive process, we reiterated the harms that people with pain – including our members – have been experiencing as a result of the current Guideline. We urged that the updated Guideline include specific changes, including explicit caution against alignment with specific dose thresholds or duration limits, provisions addressing and restoring access to care people with pain have lost as a result of the 2016 Guideline, acknowledgement of the limitations of the evidence underlying the Guideline (including, but not limited to, the gaps and limitations in data surrounding morphine milligram equivalents (MMEs)), further acknowledgement of the recent unsafe tapering practices with a pathway for people to return to a previously effective dose, and more. Some of this has been included in the update to the Guideline, for which we are grateful, but more needs to be done.
