Editorial: CDC Proposes Opioid Guidelines

Sunday, January 03, 2016
Faced with an addiction crisis that cost more than 47,000 Americans their lives through drug overdoses in 2014, the federal Centers for Disease Control and Prevention this fall drafted prescription guidelines for medical professionals aimed at reining in the use of opioid painkillers. Given that this effort is being vigorously opposed by the powerful industry that makes these powerful but highly addictive drugs, it’s hard to have much confidence that it will succeed.

The guidelines, which would not be binding, urge physicians to first treat chronic pain with other methods, such as physical therapy and non-opioid analgesics, before resorting to such opioids as OxyContin or Percocet. If they conclude such medications are necessary, the CDC recommends the lowest possible dose, short-term prescriptions and short-acting versions over extended-release formulas that are more likely to be abused.

“What we want to just make sure is that doctors understand that starting a patient on an opiate is a momentous decision,” said CDC director Tom Frieden.

The guidelines were supposed to go into effect this month, but the date has been pushed back in the face of a lobbying effort by pharmaceutical-industry-funded groups such as the U.S. Pain Foundation and the American Academy of Pain Management, The Associated Press reported last month. They claim that the guidelines could block patients from getting the medications they need (although the recommendations would not apply to patients who are dying or suffering from severe chronic pain associated with diseases such as late-stage cancer).

Moreover, these groups contend that the guidelines were drafted behind closed doors, without adequate public involvement. Maybe that’s because the CDC feared the effort would be undermined by giving too much notice to an industry with a big financial interest in protecting an opioid business that racked up $9 billion in sales in 2014.

Beyond that, though, medical professionals might well be concerned that the guidelines would impair their ability to treat patients whose long-term chronic pain is eased by opioid painkillers, especially if insurance companies adopted the recommendations as the basis for coverage decisions. And many physicians are understandably jealous of their autonomy in making treatment decisions, so they may resent an intrusion by a federal agency in the doctor-patient relationship.

Still, there is a very compelling case that overprescription of opioids is rife. In 2012, health care providers wrote 259 million prescriptions for opioids, which, the CDC noted, was “enough for every adult in the United States to have a bottle of pills.” Meanwhile, the number of overdose deaths from legal opioid drugs increased by 16.3 percent nationwide in 2014, while overdose deaths from heroin rose by 28 percent. (When some people who become addicted to an opioid painkiller lose access to it or can’t afford it, they turn to its cheaper and readily available cousin, heroin.)

Closer to home, the death toll in New Hampshire from opioid-related overdoses was 244 during the first 294 days of 2015, staff writer Rick Jurgens reported in November. And in Vermont, opioids were a factor in 55 overdose deaths in the first nine months of 2015.

The CDC’s proposed guidelines appear to be a sensible start to addressing this crisis, not least on the grounds that health care ought to be provided on a continuum starting with the least intrusive or risky intervention. Making that expectation explicit in the management of chronic pain is only one of many steps on many fronts that could save lives that now stand to be lost or squandered.