An article appearing earlier this week in Pain Network News features commentary from PAINWeek senior faculty member Forest Tennant, MD, DrPH, FACPM, MPH, on the draft guidelines for opioid prescribing recently released by the Centers for Disease Control (CDC). The CDC guidelines state that physicians “should avoid” increasing opioid doses over a certain level -- 90 milligrams MEQ (morphine equivalent) a day. If that dose level is insufficient to provide pain relief, the CDC recommends that doctors “should consider working with patients to taper and discontinue opioids.”
Dr. Tennant, Medical Director at Veract Intractable Pain Clinic, West Covina, CA, and editor in chief of Practical Pain Management, asserted “The CDC draft and activity is disturbing. Their guidelines are good, but their 90mg ceiling is a problem. The word ‘avoid’ in traditional pharmaceutical prescribing usually means don't exceed the dose unless absolutely necessary. I would like to see the 90mg dosage be preceded or followed with the statement ‘whenever possible.’” Tennant added “The major issue here is whether legacy patients -- those given high opioid dosages in the past when there were no alternatives -- can continue. New patients seldom need to go over 90mg as we now have non-opioid neuro-inflammatory and neuro-hormonal therapies.” Read more, including additional commentary from American Academy of Pain Medicine past president Lynn Webster, MD, here.