By Beth Darnall, PhD: For Complete Post, Click Here…
ngd- This is an important policy critique and should be read by everyone involved in the chronic pain community…
In 2016, the U.S. Centers for Disease Control (CDC) issued its Guideline for Prescribing Opioids1and cautioned physicians and clinicians about starting new opioid prescriptions, as well as increasing the dose of existing opioid prescriptions. One year after it was published, national retail pharmacy data revealed that opioid prescribing had decreased by 57% each month in the United States over the preceding year.2
At their core, these rigid opioid dose policies violate the basic principles of patient-centered pain care while deeply undermining physician autonomy in medical decision-making for the individual patients they treat.
This same study showed that while decreased opioid prescribing preceded the 2016 CDC Guideline, the slope of prescribing decreased substantially afterward. Indeed, the guideline emboldened opioid reduction practices and policies in ways that its authors never intended. Since 2016, opioid prescribing decreases have been attributable to fewer new opioid prescriptions and the tapering of opioids among people who had been taking them long term. This last point is of particular relevance as the CDC Guideline included no language about opioid tapering indications or implementation.
At their core, these rigid opioid dose policies violate the basic principles of patient-centered pain care while deeply undermining physician autonomy in medical decision-making for the individual patients they treat.
Curiously, improving patient safety through opioid reduction is a primary justification cited for policies that mandate opioid tapering. Indeed, data suggest that higher doses of opioids are directly associated with risk for opioid overdose and overdose death. However, for many patients, the consequence of the misapplication of the CDC Guideline has been direct harm. Reports of iatrogenic tapering harms spurred colleagues and me to submit to U.S. Health and Human Services (HHS) a letter calling for federal action to protect patients from abrupt and forced opioid tapering harms (subsequently published in Pain Med3).
