CDC Delays Opioid Prescribing Guidelines

By Pat Anson, Editor

Faced with the threat of lawsuits and growing ridicule from patients, physicians and other federal agencies, the Centers for Disease Control and Prevention (CDC) has apparently decided to delay for several months plans to implement its controversial opioid prescribing guidelines for chronic pain.

Today the agency filed a formal notice in the federal register that it was opening a 30-day public comment period on the guidelines, which had been scheduled for adoption in January. The guidelines would discourage primary care physicians from prescribing opioid pain medication in an effort to end what has been called an “epidemic” of addiction and overdoses.

“In response to feedback, CDC is posting its draft opioid prescribing guideline for chronic pain in the Federal Register for 30 days of public comment. In addition, in early 2016 the CDC National Center for Injury Prevention and Control’s Board of Scientific Counselors (BSC), a federal advisory committee, will review the draft guideline. CDC will ask the BSC to form a workgroup to review the guideline and public comments and present recommendations to the BSC,” the CDC said in a statement to Pain News Network.   

The public comment period will run from December 14th  until January 13, 2016.

The CDC unveiled the guidelines in September to a select online audience and then only allowed a 48-hour public comment period. The agency was roundly criticized for its secrecy during the drafting of the guidelines and for consulting with special interest groups, but few pain patients or pain physicians. The agency never made the guidelines available on its website or in any public form outside of the webinar.

A spokesperson told PNN the guidelines will finally become available for public scrutiny on Monday when they are published in the federal register.

A list of the dozen draft guidelines that were released in September can be found here. They recommend “non-pharmacological therapy” as the “preferred” treatment for non-cancer pain, and state that limited quantities and doses of opioids should be prescribed for both acute and chronic pain. The CDC later said the draft guidelines were being revised, but didn't release the changes.

Last week, a key government panel that oversees pain research indicated it would file a formal objection to the guidelines. Politico reported that the National Institute of Health’s Interagency Pain Research Coordinating Committee believes there is little or no evidence to support many of the prescribing guidelines. Some committee members reportedly called the agency’s recommendations “ridiculous” and “an embarrassment to the government” during a meeting.

Sharon Hertz, a top FDA official, was quoted as saying the evidence used to support the guidelines "is low to very low and that's a problem."

Another top official in the Department of Health and Human Services told the research committee the CDC’s guidelines were “shortsighted” and there was a rush to judgement.

"You know, damn the torpedoes. Full speed ahead," said Wanda Jones, principal deputy assistant secretary for health at HHS.

The Washington Legal Foundation (WLF) also signaled it was prepared to file a lawsuit to stop the guidelines from being implemented, accusing the CDC of “blatant violations” of federal law for not holding public hearings and refusing to publicly identify members of its advisory committees.

“The overly secretive manner in which CDC has been developing the Guideline serves the interests of neither the healthcare community nor consumers,” wrote WLF chief counsel Richard Samp to CDC director Tom Frieden.

In a survey of over 2,000 patients by Pain News Network and the Power of Pain Foundation, over 90% said the guidelines were discriminatory and would be more harmful than helpful to pain patients. Most said they had already tried non-opioid treatments, such as massage, acupuncture and cognitive behavioral therapy, and found that they didn’t work or were not covered by insurance. Many predicted the guidelines would lead to more suicides in the pain community, and cause more addiction and overdoses, not less.