CDC, Regenstrief Agree: Opioid Guideline Misapplied

Overeager Use of Recommendations Creates Problems

Citing the findings of a review panel led by the Regenstrief Institute, the Centers for Disease Control and Prevention (CDC) is clarifying its guideline on opioid prescribing. The panel found that many clinicians, policymakers, and payers are misapplying the guideline, causing a detrimental effect on patients.

The new guidance was published in the New England Journal of Medicine, and CDC officials will continue to review the policy and its effects, making changes as necessary.

Issued in 2016, the original guideline was a response to the dramatic increase in abuse of opioid medications. Recommendations include having patients use other pain treatments first, limiting opioid doses and prescriptions, and discussing their risks with patients. But the guideline is not intended to be inflexible.

While the panel, chaired by Dr. Kurt Kroenke, mainly supported the original guideline, they discovered that in some cases, the recommendations had been applied too enthusiastically. Some clinicians and payers have enforced severe limits on opioid doses, regardless of a patient’s situation. Some patients have had prescriptions abruptly tapered or suddenly stopped, which can have negative consequences. Also, recommendations have been applied to patients outside the guideline’s scope, such as those in active cancer treatment or patients dealing with post-surgical pain.

New recommendations were developed by the panel to address issues surrounding guideline applications; these include producing a validated tapering protocol, and clarifying the fitting clinical application of recommended dosage thresholds based on the individual patient. The proposals are intended for regulators, policymakers, and payers.

The report, Challenges with Implementing the Centers for Disease Control and Prevention Opioid Guideline: A Consensus Panel Report, was published in the April issue of Pain Medicine. 

Source: Regenstrief Institute, May 13, 2019