CDC Clarifies Guidelines for Prescribing Opioids for Chronic Pain

The U.S. Centers for Disease Control and Preventions recently released a letter clarifying its 2016 Guideline for Prescribing Opioids for Chronic Pain.  The letter is actually dated 2/28/19, and was written by Deborah Dowell, MD, Chief Medical Officer, CDC National Center for Injury Prevention and Control, and a co-author of the 2016 Guideline.  The clarification letter addresses concerns of physicians caring for patients with cancer, sickle cell disease, and other serious illnesses.  Treatment options for pain are often being limited by laws or denied by insurers who say they are following the 2016 Guideline.  In her letter, Dr. Dowell restates that the 2016 Guideline “provides recommendations for primary care clinicians who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care.” [My underline.]  She then notes “Because of the unique therapeutic goals, and balance of risks and benefits with opioid therapy in such care, clinical practice guidelines specific to cancer treatment, palliative care, and end of life care should be used to guide treatment and reimbursement decisions regarding use of opioids as part of pain control in these circumstances.”  Dr. Dowell also cites “useful guidance” documents, including the American Society of Clinical Oncology Management of Chronic Pain in Survivors of Adult Cancers, the National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Adult Cancer Pain, and the National Heart, Lung, and Blood Institute’s Evidence Based Management of Sickle Cell Disease Expert Panel Report.