Five health care professionals with extensive experience in pain management and addiction practice are making a public call for the Centers for Disease Control (“CDC”) to clarify guidance issued in 2016 concerning opioid pain management therapies. The group, made up of five physicians and a pharmacist and writing under the collective name Health Professionals for Patients in Pain, said in a letter published Sept. 24, 2018, that certain aspects of the guidance have led to serious negative and unintended consequences for patients and health care providers. The authors are requesting that other health care professionals endorse this effort by publicly signing on to the letter to the CDC.

The group states in the letter that there is evidence of “widespread misapplication” of the guidelines among physicians, pharmacists, insurers, and regulators. In particular, the group says the CDC’s recommendation for physicians to exercise extra precautions in prescribing daily dosages above 90 morphine milligram equivalents (“MMEs”) has been twisted into a “de facto daily dose limit.” The result has been a cloud of suspicion on physicians prescribing opioid medication above 90 MMEs per day, on pharmacists filling these prescriptions, and on patients prescribed dosages above 90 MMEs per day regardless of medical need. Misinterpretation of the CDC’s guidance has led to coverage barriers for opioid prescriptions, demands from pharmacies to review medical charts, required medication tapering plans before filling medically appropriate opioid prescriptions, and the threat of professional and legal risks for physicians.

The letter’s authors state that the impact on patients from misapplication of the CDC’s guidelines has been particularly dire. Chronic pain patients who are stable and have a medical need for higher opioid medication dosages have been subject to dose reductions, and frequently face a lack of alternate pain therapies, or lack of insurance coverage of alternate therapies, according to the group. Patients forced to undergo reductions in their prescribed opioid medication include documented cases of suicide, illicit drug use, hospitalizations, and deterioration of their health.

The Health Professionals for Patients in Pain are requesting that the CDC explicitly clarify its direction to physicians on the prescribing of opioid therapies to address misapplication of the guidance, with a particular focus on opioid therapy tapering and discontinuation. In addition, the authors are asking the CDC to consult with patients and caregivers, as well as epidemiologic experts, to evaluate the real-world impact of the guidelines, including reports of suicides, suicidal ideation, and illicit drug use among patients forced to undergo opioid medication tapering or discontinuation.