CDC issues guidelines against opioid prescriptions to treat chronic pain
Opioids are commonly prescribed because they are effective in relieving many types of pain. These medications are classified as narcotics and can be dangerous when abused. When used properly, they have been known to help in severe pain that follows surgery and to alleviate cancer patients suffering.
The US agency has issued new guidelines for advising doctors against prescribing opioids to treat chronic pain in the interior of a deadly national opioid epidemic and a clash between addiction advocates and some groups focused on pain treatment.
According to Andrew Kolodny, the director of Physicians for Responsible Opioid Prescribing “It's a game-changer” and by the chief medical officer of Phoenix House, “It's the first time that the federal government is clearly communicating to the medical community that opioids are not appropriate for long term use, that the risks outweigh the benefits.” Centers for Disease Control and Prevention (CDC) guidance described that a rare move for the organization that typically leaves drug regulation to the Federal Drug Administration which was prompted by the rapidly increasing number of deaths from prescription opioids. As the CDC guidelines are not legally binding, still the agency's recommendations were issued despite dogged advocacy by pain management groups who receive funding from pharmaceutical companies.
Massachusetts Governor Charlie Baker signed a bill that has limited the first-time patients to seven day prescriptions earlier in the week and it was mandatory for patients to register into a statewide monitoring system. Maine governor Paul Le Page conveyed on limiting prescriptions for both chronic and acute pain and capping doses to 100 morphine mg equivalents/day. As per Bob Twillman, executive director for the American Academy of Pain Management, “It reflects a lack of experience in treating people with chronic pain”. According to the CDC (1999), prescription opioid deaths have quadrupled and was more than 40 people/day. Heroin and fentanyl further increases those numbers. In 2014, more than 28,647 people died from opioid overdoses.
As per guidelines, opioids should not be prescribed as first-line therapy and they exempt treatment for cancer, palliative care and end-of-life care. The doctors should evaluate the decisions to prescribe more than 50MME/day and avoid/carefully consider prescribing more than 90MME. The Washington Legal Foundation accused the CDC of violating federal law by initially refusing to disclose the “Core Expert Group” who drafted the initial guidelines.
The most notable resistance came from the Inter Agency Pain Research Coordinating Committee, which complained that there were not enough pain providers represented in the group, and questioned the CDC’s studies saying that opioids were not effective in treating long-term pain. Dr. Deborah Dowell, the lead author of the CDC guidelines said that the considerations of pain advocates were addressed in the recent draft and that the final version allowed recommendations of up to seven days of treatment and doses more than 90MME.
Deb Houry, the CDC’s director of National Center for Injury Prevention and Control said “does acknowledge cost and access as real barriers to a broader array of therapies” and that the agency is committed to work with federal partners to strengthen coverage of pharmacological treatments. CDC specified that these parameters were not applicable to cancer patients. The advocacy organization’s president Chris Hansen said: “The guidelines disregard the impact on cancer survivors. Pain does not end when an individual completes treatment. Most often, cancer patients deal with lasting effects from their disease or treatment including pain for a significant period of time or indefinitely,”
Pharmaceutical companies also give funds to the organization- $2.184 million in 2015 according to the organization. But spokeswoman Alissa Crispino said it’s a very small part of their revenue. “The American Cancer Society Cancer Action Network (ACS CAN) had $36.4 million in revenues in 2015 – approximately $32 million through a grant from the American Cancer Society and nearly $4.4 million through direct contributions,” Crispino said.