Authority figures are still intentionally disinforming health professionals about the recommendations in the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain.
The cure for disinformation from authority figures is for health professionals to read the original source yourselves and interpret the meaning of sentences, paragraphs and phrases as you would any other important literature, and use dictionaries. Propagandists rely upon people being too lazy to read and think for themselves.
The following is yet another concise plea from the CDC exposing misapplications of its Guideline. Read and share this widely.
CDC Advises Against Misapplication of the Guideline
for Prescribing Opioids for Chronic Pain
Some policies, practices attributed
to the Guideline are inconsistent with its recommendations
Media Statement
Embargoed Until: Wednesday, April
24, 2019, 5 PM, EDT
Contact: Media Relations
(404) 639-3286
In a new commentary external icon in the New England Journal of Medicine (NEJM),
authors of the 2016 CDC Guideline for Prescribing Opioids for Chronic
Pain (Guideline) advise against
misapplication of the Guideline that can risk patient health and safety.
CDC commends efforts by healthcare
providers and systems, quality improvement organizations, payers, and states to
improve opioid prescribing and reduce opioid misuse and overdose. However, some
policies and practices that cite the Guideline are inconsistent with, and go
beyond, its recommendations. In the NEJM commentary, the authors outline
examples of misapplication of the Guideline, and highlight advice from the
Guideline that is sometimes overlooked but is critical for safe and effective
implementation of the recommendations.
CDC is raising awareness about the
following issues that could put patients at risk:
- Misapplication of recommendations to populations
outside of the Guideline’s scope.
The Guideline is intended for primary care clinicians treating chronic
pain for patients 18 and older. Examples of misapplication include
applying the Guideline to patients in active cancer treatment, patients
experiencing acute sickle cell crises, or patients experiencing
post-surgical pain. - Misapplication of the Guideline’s dosage recommendation
that results in hard limits or “cutting off” opioids. The Guideline states, “When opioids are started,
clinicians should prescribe the lowest effective dosage. Clinicians
should… avoid increasing dosage to ≥90 MME/day or carefully justify
a decision to titrate dosage to ≥90 MME/day.” The recommendation statement
does not suggest discontinuation of opioids already prescribed at higher
dosages. - The Guideline does not support abrupt tapering or
sudden discontinuation of opioids.
These practices can result in severe opioid withdrawal symptoms including
pain and psychological distress, and some patients might seek other
sources of opioids. In addition, policies that mandate hard limits
conflict with the Guideline’s emphasis on individualized assessment of the
benefits and risks of opioids given the specific circumstances and unique
needs of each patient. - Misapplication of the Guideline’s dosage recommendation
to patients receiving or starting medication-assisted treatment for
opioid use disorder. The
Guideline’s recommendation about dosage applies to use of opioids in the
management of chronic pain, not to the use of medication-assisted
treatment for opioid use disorder. The Guideline strongly recommends
offering medication-assisted treatment for patients with opioid use
disorder.
The Guideline was developed to
ensure that primary care clinicians work with their patients to consider all
safe and effective treatment options for pain management. CDC encourages
clinicians to continue to use their clinical judgment, base treatment on what
they know about their patients, maximize use of safe and effective non-opioid
treatments, and consider the use of opioids only if their benefits are likely
to outweigh their risks.
The Guideline includes guidance on
management of opioids in patients already receiving them long-term at high
dosages, including advice to providers to:
- maximize non-opioid treatment
- empathetically review risks associated with continuing
high-dose opioids - collaborate with patients who agree to taper their dose
- if tapering, taper slowly enough to minimize withdrawal
symptoms - individualize the pace of tapering
- closely monitor and mitigate overdose risk for patients
who continue to take high-dose opioids
Patients may encounter challenges
with availability and reimbursement for non-opioid treatments, including
nonpharmacologic therapies (e.g., physical therapy). Efforts to improve use of
opioids will be more effective and successful over time as effective non-opioid
treatments are more widely used and supported by payers.
CDC developed the Guideline to be
practical and created clinical tools to help primary care providers help
patients manage pain more effectively and safely, while mitigating the
potential risks of prescription opioids when needed. CDC has also created
specific resources on tapering, dosage, and appropriate application of the
Guideline such as:
- Pocket Guide: Tapering
Opioids for Chronic Pain
is a quick-reference tool for when and how to taper and important
considerations for safe and effective care. - CDC Opioid Prescribing Guideline Mobile App is designed to help providers apply the
recommendations of the Guideline in clinical practice. It features a
morphine milligram equivalent (MME) calculator, summaries of key
recommendations, motivational interviewing techniques, resources, and a
glossary. - Applying CDC’s Guideline for Prescribing
Opioids Series is an interactive, web-based
training featuring 11 self-paced learning modules with case-based content,
knowledge checks, and integrated resources to help providers gain a deeper
understanding of the Guideline.
CDC continues to help inform and
improve clinicians’ ability to offer safer, more effective care based on the
best available science. As part of that process, CDC is evaluating the
adoption, use, and public health impact of the Guideline and its related
resources.