AMA seeks overhaul of CDC opioid prescribing guidelines

The American Medical Association is calling for the Centers of Disease Control and Prevention to overhaul its 2016 opioid prescribing guidelines. The organization says the guidelines limit patients access to pain management treatments.

In a letter sent to the CDC on Thursday, the AMA argued the agency’s landmark, prescribing guidelines issued in response to the opioid crisis were failing to address how the epidemic has evolved. Drug overdose deaths rose by 30% from 2019 to 2020 to a record 93,000 despite prescribing restrictions becoming a widely adopted practice among most healthcare providers since the release of the guidelines.

Fueling the trend has been illicit sales of fentanyl, which made up 60% of overdose deaths in 2020, according to CDC data. Experts have warned mental anguish caused by the pandemic coupled with months of limited access to in-person addiction treatment services would likely lead to increased drug use among those at higher risk.

The letter is the latest call by the AMA for a change to the guidelines. For years, the group has argued that the CDC’s prescribing recommendations – intended to aid primary care clinicians in making decisions on prescribing opioids for adult patients with chronic pain – have been misapplied and used as the premise to employ broader prescribing limits than were intended.

It is a point the CDC itself has acknowledged. Authors of the CDC guidelines in a 2019 commentary published in the New England Journal of Medicine warned against applying the recommendations in a way that could potentially harm patients like setting dose thresholds that could lead clinicians to abruptly cut patients off or taper down dose levels too quickly.

“CDC’s threshold recommendations continue to be used against patients with pain to deny care,” wrote Dr. Bobby Mukkamala, chairman of the AMA’s Board of Trustees in the letter to the CDC. “We know that this has harmed patients with cancer, sickle cell disease, and those in hospice – the restrictive policies also fail patients who are stable on long-term opioid therapy.”

Since the release of the guidelines many health systems have sought to change their pain management practices by limiting patients’ exposure to prescription opioids in favor of using less addictive alternative treatments like acetaminophen and ibuprofen for post-surgical recovery.

The CDC guidelines were associated with decreases in post-operative opioid dispensing in the two years following their release compared to the two years prior to them being published, according to the findings of a study published in April in the Journal of the American Medical Association.

Some of the AMA’s points regarding the guidelines were acknowledged in a report released earlier this month by a CDC working group tasked with reviewing potential revisions to the prescribing guidelines.

Though the report stated several workgroup members “voiced concern” over some of the recommendations, others stated concern over possibly “over-correcting” guideline problems identified to a point where it could prove detrimental to the overall good that has resulted.