Since the Centers for Disease Control and Prevention (CDC) issued strict guidelines to curb inappropriate patterns of opioid prescription, the prescribing rate has declined. However, experts are concerned that patients with chronic pain (like patients with cancer) may be missing out on the treatment they require.
More than 300 medical experts co-signed a letter to the CDC arguing that misapplication of the guidelines is unintentionally harming vulnerable patients; some clinicians, the authors contend, may be misusing the guidelines to deny opioids to patients with chronic pain or to deny reimbursement.
The authors also request that the CDC clarify the appropriate use of the guidelines and emphasize that treatment decisions for patients with chronic pain are left to the doctor and patient. “It is imperative that health-care professionals and administrators realize that the guideline does not endorse mandated involuntary dose reduction or discontinuation,” the group wrote.
In The New York Times, a CDC spokesperson stated that the guidelines “do not endorse mandated or abrupt dose reduction or discontinuation,” adding that the agency is investigating the impact of the guidelines. Still, insurers and regulators have implemented some of the dosage restrictions into their policies. For example, the insurer Aetna limits members to 90 morphine milligram equivalents per day, based on information in the CDC guidelines. If higher doses are needed, prescribers can seek special permission from the insurer.
Source: The New York Times, March 6, 2019.