Authors of the CDC Guideline for Prescribing Opioids for Chronic Pain Advise Against Misapplication

April 26, 2019

Authors of the Centers for Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain advise against misapplication of the Guideline, that can risk patient health and safety, in a new commentary in the New England Journal of Medicine (NEJM).

The authors of this commentary commend the efforts of many stakeholders (health care providers and systems, quality improvement organizations, payers, etc.) to improve opioid prescribing and reduce opioid misuse and overdose; but acknowledge that some policies and practices purportedly derived from the guideline are inconsistent with, and go beyond, its intent and recommendations.

The CDC commentary clarifies that:  

• Misapplication of recommendations to populations outside of the Guideline’s scope.
• Misapplication of the Guideline’s dosage recommendation that results in hard limits or “cutting off” opioids.
• The Guideline does not support abrupt tapering or sudden discontinuation of opioids.
• Misapplication of the Guideline’s dosage recommendation to patients receiving or starting medication-assisted treatment for opioid use disorder.

This commentary follows a recent safety announcement from the U.S. Food & Drug Administration (FDA), stating that they have received reports of serious harm in patients from sudden discontinuation of opioid pain medicines.

The CDC is evaluating the (intended and unintended) impact of the guideline and other health system strategies on clinician and patient outcomes, but encourages continued implementation of the recommendations consistent with the guideline’s intent.