Responding 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 2016 Guideline for Prescribing Opioids for Chronic Pain—United States. On February 9, 2022, it released a draft proposal and is seeking comments from interested parties over the next 60 days. It intends to release an updated set of guidelines by the end of this year.
As Josh Bloom, Director of Pharmaceutical and Chemical Science at the American Council on Science and Health explains here, the proposal is a 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.”
Unfortunately, as I explain here, and in testimony before the Arizona Senate Health and Human Services Committee here, the guidelines still cling to a 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.
Also unfortunate is that 36 states 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.
State 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.
