With four years having passed since the Centers for Disease Control and Prevention (CDC) published their Guideline for Prescribing Opioids for Chronic Pain, the CDC recently opened up a comment period to allow a broad range of stakeholders to provide their perspectives on public health challenges tied to pain, opioids, diversion, overdose, the CDC guidelines, and more.
The American Medical Association (AMA) submitted their comments in a 17-page letter, stating their belief that the U.S. no longer has a prescription opioid-driven epidemic, but rather an overdose epidemic driven by heroin and illicit synthetic opioids.
Citing prescription opioid decreases, the increased utilization of prescription drug monitoring programs (PDMPs), increased provider education requirements, a higher number of physicians now certified to treat opioid use disorder, and increased naloxone prescribing, the AMA is asking the CDC to remove certain limits and restrictions placed on opioid prescribing.
Suggesting that various entities have used the CDC guidelines to create excessive restriction across the board for opioids, the AMA believes these limits and restrictions create a stigma around pain management, resulting in the denial of care. Furthermore, the AMA takes the position that the CDC Guideline has harmed patients because various organizations have adopted the guidelines as hard policies, when certain patients may benefit from opioid prescriptions that exceed CDC thresholds.
The AMA suggests that the following policies currently serve as barriers to evidence-based care:
- Prior authorization
- Step therapy
- Quantity limits
- High cost-sharing
- Coverage limitations on medications for treating opioid use disorder
- Coverage limitations on opioid and non-opioid medications
- Coverage limitations for non-pharmaceutical therapies for managing pain
Furthermore, the AMA states that while opioid supplies have decreased in volume and strength, there has not been a concomitant increase in access to or affordability of evidence-based non-opioid alternatives.
Within their letter, the AMA suggest 13 recommended changes to improve the CDC guideline, all of which fall under the following three tenets:
- Many patients experience pain that is not well controlled, substantially impairs their quality of life and/or functional status, stigmatizes them, and could be managed with more compassionate patient care
- The revised CDC guideline should be used as part of a coordinated federal strategy to help ensure patients with pain receive comprehensive care delivered in a patient-centric approach
- Policymakers, payers, and other stakeholders should suspend use of the CDC Guideline as a hard policy for limiting, discontinuing, or tapering a patient’s opioid therapy