New CDC Guidelines May Lead to Patient Suffering
This week, the Centers for Disease Control and Prevention (CDC) posted new draft guidelines for primary care physicians who prescribe prescription opioids to patients suffering from chronic pain. The recommendations encourage doctors to be much more austere when prescribing prescription pain medication, and if finalized, the recommendations will set precedent of the federal government exerting influence over physician prescribing practices.
The recommendations aim to address the sharp rise in opioid abuse and misuse, a problem that has significantly increased in both youth and adults in the U.S. over the past 15 years. However, interest groups have raised questions about the lack of transparency in selecting members of and also the conduct of the CDC’s Advisory Committee on this issue.
The Guideline for Prescribing Opioids for Chronic Pain (The Guideline) outlines the CDC’s recommendation to doctors for initiation and continuation of prescription opioid use, including direction on which pain medication to prescribe, dosage levels and duration of use of the prescribed medicine.
In the healthcare space, chronic pain is a significant issue. When accounting for lost productivity at work, chronic pain imposes between $560 billion and $635 billion in annual healthcare costs. Prescription medicines are powerful tools to assist many people who suffer from chronic pain more effectively manage their symptoms.
In developing The Guideline, the CDC did not take the opportunity to recommend alternative reform options that do not include influencing a physician’s ability to prescribe a medicine they believe will be the best option for their patients. For instance, New York state has implemented advanced analytics in their state health agency for use in anomaly detection, predictive modeling and social network analysis to empower health professionals to confidentially evaluate millions of prescription records (almost instantaneously) and pinpoint highly suspicious behaviors, while allowing the vast majority of compliant physicians to treat patients as they deem medically appropriate.
Also, the increased presence of abuse-deterrent opioids is a relatively new innovation for managing the opioid abuse problem. There are multiple abuse-deterrent opioid medications on the market, however; an example of one includes neutralizing the agent that creates the euphoric feeling while maintaining the pain-relief for the patient. These medicines have been designed for use with patients who are determined to be at a higher risk through a clinical questionnaire or other screening tool used to identify individuals at risk for misusing or abusing opioid analgesics.
Other free-market reform ideas include increased education efforts of patients by physicians (that should also include physician-patient contracts); serially numbering prescriptions; photo ID requirements for patients when picking up their medicines from the pharmacy; enhanced efforts to monitor controlled substances from manufacturer to pharmacy to reduce theft during the distribution process; and safe disposal provisions for unused opioids.
It is critical that pain patients receive medically necessary therapies, with the decision on what to prescribe resting between doctor and patient. The proposed recommendation on restrictive prescribing practices is not only heavy-handed but is completely unnecessary in the discussion on prescription opioid abuse and misuse. The draft guidelines are open for public comment on the federal register through January 13, 2016.