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The CDC Opioid Prescribing Guidelines 3 Years In…

A Summary of Patient and Provider Reaction Paints a Bleak Picture

An article in yesterday’s edition of Pain Network News summarized conclusions from a recently conducted survey of healthcare providers on the impact of the CDC prescribing guideline on their patients and their practice. The news wasn’t good. To the overall question “Has the CDC guideline improved the quality of pain care?” 83% of respondents answered NO, with 9% responding YES, and 8% not sure. Criticism focused particularly on the recommendation to limit dosing to 90 morphine milligram equivalents (MME), with one respondent remarking, “There are reasonable elements to the guidelines which should be preserved. However, setting an upper dose limit, especially one so low, severely interferes with titrating the opioids to their most effective doses, which is often much higher than 90 MME.” Responses also illuminated increasing fear of prosecution for prescribing opioids, and a misperception—by prescribers, payers, and pharmacies—that the guideline is mandatory with the result that patients’ pain is increasingly undertreated.

Timed to coincide with the 3rd anniversary of the CDC guideline announcement in 2016, the PNN survey reached out to some 6,000 patients and practitioners online and through social media from February 17 to March 15. A total of 5,856 patients and 157 practitioners responded. The authors noted that, although the sample size of practitioner response was small in comparison to patients, it spanned a broad spectrum of providers including primary care, pain specialists, palliative care, surgery, pharmacy, nursing, and addiction treatment. Respondents referred to increasing scrutiny of PDMPs by enforcement agencies to profile a prescriber’s practice as contributing to reluctance to prescribe opioids. They also highlighted bias in the drafting of the guideline and noted the absence of study findings to reevaluate its impact that were promised by the CDC at the time of release.

Read the summary, with link to more feedback from patients and providers.

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