The Center for U.S. Policy (CUSP) recently submitted a comment in response to a Centers for
Disease Control and Prevention (CDC) information request titled, “Comprehensive Evaluation of
the Implementation and Uptake of the CDC Clinical Practice Guideline for Prescribing Opioids
for Pain.” The comment emphasized the ongoing misinterpretation of the CDC’s opioid
prescribing guideline, despite the agency’s efforts to clarify its recommendations.
The 2016 Clinical Practice Guideline for Prescribing Opioids for Pain (Guideline) led to laws and
policies that contributed to patient harm. The CDC’s 2022 update sought to rectify this problem
by clarifying that the guideline should not be applied as a rigid standard; however,
misinterpretation persists, leading to harmful consequences.
Many states have enacted laws and regulations that misapply the Guideline by turning voluntary
recommendations into mandatory standards. The Guideline has been improperly used by law
enforcement agencies, such as the Drug Enforcement Administration (DEA), to investigate and
prosecute healthcare providers. State medical boards have also used the Guideline to justify
disciplinary actions against physicians, creating an environment where providers are hesitant to
prescribe opioids out of fear of losing their licenses. Moreover, health insurers have also used
the Guideline to limit coverage for opioid medications, leading to delays, denials, and restricted
access to necessary treatments for people with long-term pain.
The letter also highlights concerns about prescription drug monitoring programs (PDMPs) and
their use of algorithmic risk-scoring software to influence opioid prescribing. These tools often
generate inaccurate risk assessments, pressuring providers to reduce or discontinue opioid
prescriptions.
To address these issues, CUSP urged the CDC to take the following actions:
1. Publicly report examples of how its 2016 and 2022 Practice Guideline has been
misinterpreted in:
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- a. Governmental laws, regulations, and administrative rules;
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- b. Law enforcement actions, prosecutions, and convictions;
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- c. Licensing board disciplinary actions; and
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- d. Health insurers’ coverage policies.
CUSP is also aware of the misapplication of the Guideline in civil litigation against
prescribers and in health care programs’ clinical policies.
2. Publicly call for changes to laws and policies that exceed CDC’s present-day purposes
for the Guideline;
3. Publish a statement on the differences between controlled substance laws and clinical
guidelines and disavow strict application of the Guideline in legal and regulatory
contexts; and
4. Examine and report how proprietary algorithms used by state public health and safety
officials have impacted prescriber behavior and patient outcomes, including denials of
medically necessary controlled medications, associated health crises, and deaths by
suicide.
Read the letter here.