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The Centers for Disease Control and Prevention said many physicians were guilty of a “misapplication” of 2016 opioid prescribing guidelines.
BY: JAYNE O’DONNELL AND KEN ALLTUCKER, USA TODAY
APRIL 24, 2019 AT 2:08 PM
Doctors are misusing 2016 opioid pain medication guidelines, federal officials said Wednesday, a clear response to increasing complaints from chronic pain patients who say they are the victims of an overreaction to the opioid crisis.
The Centers for Disease Control and Prevention, in new guidance for opioid prescribing, said many physicians were guilty of a “misapplication” of 2016 guidelines that clamped down on the use of opioids. The new guidelines, published in the New England Journal of Medicine, was the latest federal acknowledgement that many physicians’ responses to the opioid crisis went too far.
Former Food and Drug Administration commissioner Scott Gottlieb, a physician, spoke out last July about the impact the opioid crisis response had on pain patients when he called for development of more options.
Until then, people in the middle of cancer treatments, having “acute sickle cell crises” or with pain after surgery shouldn’t be affected by the earlier recommendations, CDC said. These patients were outside the scope of the guidelines, which were intended for primary care doctors treating chronic pain patients, CDC said.
Doctors that set hard limits or cut off opioids are also misapplying the government’s guidance, CDC said.
Doctors should prescribe the lowest effective dosage and avoid increasing it to 90 “morphine milligram equivalents” a day or “carefully justify” any decision to raise the dose to that level.
If doctors are already prescribing opioids at higher dosages – at or above the 90 MME limit – they should continue doing so if needed, CDC said.
CDC also warned against suddenly tapering or discontinuing opioids to reduce the risk of severe withdrawal symptoms including “pain and psychological distress.”
Policies that mandate hard limits conflict with the guidelines’ emphasis on individualized assessment of the benefits and risks of opioids given the specific circumstances and unique needs of each patient, CDC said.
Along with doctors reducing their dosages or refusing to continue prescribing opioids, many pain patients have lamented that they lost their doctors altogether after convictions and couldn’t find new ones willing to treat this pain.