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Patients in chronic pain have become unwitting casualties as doctors curtail the prescription of opioids. Those clinicians often cite a directive from a federal agency as the rationale — even for patients who are getting a real benefit.
Out of concern for those patients, I joined physicians Daniel Alford, Richard Dart, Stefan Kertesz, and pharmacist James DeMicco in founding Health Professionals for Patients in Pain. After a year of discussions, yesterday we released a letter, signed by over 300 health professionals from across the US, calling on the CDC to address the misapplication of its 2016 Guideline on Opioids for Chronic Pain. The letter is accompanied by over 100 pages of testimony from patients and their supporters.
Our letter endorses the Guideline’s message that opioids should “rarely” be a first option for chronic pain. However, it condemns “widespread misapplication” of the Guideline, citing actions by insurers, government agencies, quality measurement organizations, pharmacy chains, and health employers.
We have found that these organizations have often invoked the Guideline’s dose thresholds as binding for purposes of payment, determinations of quality of care, and professional and legal liability for physicians. As a result, patients on stable opioid dosages have faced “draconian and often rapid involuntary dose reductions,” resulting in grave harm.
If the CDC wishes to uphold its own goals and protect patients it must follow through with its commitment to evaluate the impact of the 2016 guidelines by consulting with patients and caregivers. Particularly, it must engage with health professionals reporting their patients’ suicidal ideation following the involuntary taper or discontinuation of opioids. For all parties involved, bold clarification is desperately needed on what the Guideline does and does not say.
One of the letter’s authors Stefan Kertesz, a physician and addiction specialist, puts it best:
Read the full letter here.
If the CDC wishes to uphold its own goals and protect patients it must follow through with its commitment to evaluate the impact of the 2016 opioid guidelines by consulting with patients and caregivers.
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