The CDC is in the process of updating their Guideline for Prescribing Opioids for Chronic Pain, which were originally published in 2016.
When originally published, the Guideline was celebrated for encouraging restrictions around opioid use. Currently there are guidelines in place for injured workers in a number of states – such as Arizona, California, New York, and Washington – that incorporate MME thresholds from the CDC. However, those state-level guidelines might be adjusted when the CDC implements updated Guideline.
A proposed draft of updated Guideline was published in the Federal Register, with a public comment period open until April 11, 2022.
The updated Guideline would state that opioids should not be considered first-line or routine therapy for subacute or chronic pain, encouraging the use of physical therapy, massage, and acupuncture, as well as non-opioid medications like gabapentin and ibuprofen. However, the CDC has removed their recommendation against opioid doses above 90 MME.
These new proposed changes to the Guideline were likely encouraged by industry stakeholders after the CDC opened up a public comment period for feedback on the guidelines in 2020. The American Medical Association (AMA) submitted a 17-page letter stating their belief that the U.S. no longer had a prescription opioid-driven epidemic, but an illicit epidemic driven by heroin and synthetic street opioids.
The AMA specifically requested that the CDC remove certain limits and restrictions placed on opioid prescribing, believing them to create stigma around pain management, resulting in the denial of care.
Patients, caregivers, providers, and others are encouraged to submit comments on the CDC’s draft of proposed updates to their Opioid Guideline.