More than 300 health-care experts told the Centers for Disease Control and Prevention Wednesday that the agency’s landmark guidelines for the use of opioids against chronic pain are harming patients who suffer from long-term pain and benefit from the prescription narcotics.
The health-care providers, including three former U.S. drug czars, said the CDC recommendation of a daily numerical threshold for opioid use has led insurers to refuse reimbursement, pharmacies to erect obstacles to obtaining drugs and risks for doctors who want to give out more.
“Taken in combination, these actions have led many health care providers to perceive a significant category of vulnerable patients as institutional and professional liabilities to be contained or eliminated, rather than as people needing care,” they said in a letter to the agency.
They said patients have endured unnecessary pain, turned to illegal drugs and even committed suicide.
The role of opioids for chronic pain has been one of the most contested aspects of the nationwide crackdown on narcotic prescribing. The CDC guidelines, issued in 2016, assert there is little evidence for the use of opioids against pain beyond 12 weeks.
But many patients have claimed that long-term use of the drugs is all that stands between them and unrelenting pain, and that they can take the medication without becoming dependent or addicted. The accumulation of that anecdotal evidence led to the experts, who call themselves Health Professionals for Patients in Pain, to write to the CDC.
In a statement Thursday, the CDC said the 2016 guidelines do not “endorse mandated or abrupt dose reduction or discontinuation. The guideline recommendation on high-dose prescribing is to avoid or carefully justify increasing opioid dosages above this threshold.”
The agency also noted that the guidelines cautions that “clinical decisionmaking should be based on a relationship between the clinician and patient, and an understanding of the patient’s clinical situation, functioning, and life context. The recommendations in the guideline are voluntary, rather than prescriptive standards.”
The agency said it has several studies underway that examine the impact of the recommendations.
The National Institutes of Health also is studying the issue as part of its Helping to End Addiction Long-term Initiative and last week the Food and Drug Administration ordered drug companies to examine whether opioids are effective against chronic pain.
In the meantime, the number of opioid prescriptions issued annually has fallen sharply, from a peak of more than 255 million in 2012 to 191 million in 2017, according to the CDC. Many states have enacted limits on opioid prescribing.
Still, 47,600 people died of opioid overdoses in 2017, more than 17,000 of them from legal painkillers such as oxycodone, hydrocodone and methadone.
The CDC guidelines suggest 90 milligrams of morphine or their equivalent as a daily ceiling for opioid use against pain. But the letter said insurers, regulators and others have used the figure “as both a professional standard and a threshold for professional suspicion.”
The group called on the CDC to investigate the damage that the limit may be doing to patients and to clarify the guidelines, especially in regard to discontinuing patients’ opioid use.