AMA Asking CDC To Revise Guidelines On Opioid Prescribing

Liz Carey

Atlanta, GA ( – The American Medical Association is urging the Centers for Disease Control (CDC) and Prevention to change its guidelines on opioid prescriptions, because the prescription opioid epidemic is over, it said in public comments last month.

As part of the CDC’s public comment period on its 2016 Guideline for Prescribing Opioids for Chronic Pain, the AMA urged the CDC to remove arbitrary limits and restrictions placed on opioid prescribing due to the lack of evidence that these limits improve outcomes for patients with pain.

Instead, the AMA said, the limits and restrictions place a stigma on patients with pain and have resulted in pain care being denied to patients.

“Hard thresholds should never be used. Where such thresholds have been implemented based on the previous CDC Guideline, they should be eliminated,” AMA Executive Vice President and CEO James L. Madara, M.D. wrote in the AMA’s public comments.

The problem is not prescription pain medication, he said.

“The nation no longer has a prescription opioid-driven epidemic. However, we are now facing an unprecedented, multi-factorial and much more dangerous overdose and drug epidemic driven by heroin and illicitly manufactured fentanyl, fentanyl analogs, and stimulants,” Madara wrote. “We can no longer afford to view increasing drug-related mortality through a prescription opioid-myopic lens. This is why the AMA continues its aggressive advocacy efforts in support of patients with pain and those with a substance use disorder as well as broad support for harm reduction policies and practices that address the wide range of factors affecting patients. The nation’s opioid epidemic has never been just about prescription opioids, and we encourage CDC to take a broader view of how to help ensure patients have access to evidence-based comprehensive care that includes multidisciplinary, multimodal pain care options as well as efforts to remove the stigma that patients with pain experience on a regular basis.”

The AMA said some patients with chronic or acute pain may need opioid prescriptions at doses greater than the guidelines or thresholds put in place by federal agencies, insurance plans, pharmacies or other regulatory bodies. Instead, the opioid dosage and prescribing decisions should be between the prescribing physician and the patient, the group said.

The CDC’s guidelines recommend physicians prescribe the lowest morphine milligram equivalent dosages possible and to limit dosages to less than 50 MME when possible. Physicians should also limit prescriptions to three days, one week at the most. The CDC’s Guidelines recommend physicians try non-opioid treatments first, and continually monitor patients who are prescribed opioids, as well as talking to them about the risks of long-term opioid use.

“An estimated 20% of patients presenting to physician offices with noncancer pain symptoms or pain-related diagnoses (including acute and chronic pain) receive an opioid prescription,” the CDC said in its guidelines. “In 2012, health care providers wrote 259 million prescriptions for opioid pain medication, enough for every adult in the United States to have a bottle of pills. Opioid prescriptions per capita increased 7.3 percent from 2007 to 2012, with opioid prescribing rates increasing more for family practice, general practice, and internal medicine compared with other specialties. Rates of opioid prescribing vary greatly across states in ways that cannot be explained by the underlying health status of the population, highlighting the lack of consensus among clinicians on how to use opioid pain medication.”

The AMA argued that its study of prescription methods has shown a marked decrease in opioid prescribing.

“Opioid prescriptions decreased 33 percent (more than 80 million prescriptions) between 2013-2018, including more than 12 percent (more than 20 million prescriptions) between 2017-2018 alone,” the AMA said in its letter.

The AMA also recommended that the CDC add to its recommendations that “public and private payer policies must be fundamentally altered and aligned to support payment for non-pharmacologic treatments and multimodal, multidisciplinary pain care” so that patients in pain who have been diagnosed with a co-occurring opioid use disorder would still have access to treatment for their pain.

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