In 2016, the Centers for Disease Control issued new guidelines intended to help bring the budding opioid crisis in America under control. Just months after the new guidelines went into effect, surveys indicated that more than 2/3 of patients who had been prescribed opioids saw their medication levels significantly reduced. While that might seem like a positive development, many patients were not thrilled. It also became quickly apparent that the new guidelines had created a lot of confusion and that certain myths had emerged about the new rules and their implementation.
Almost immediately after the new CDC opioid guidelines went into effect confusion became the order of the day. Some patients complained that they were forced to endure constant pain. While others claimed they were told there was nothing their doctor could do and that going forward opioids would only be prescribed for end-of-life situations. But is that true?
Let’s take a look at some of the myths that have grown up around the CDC opioid guidelines since their introduction two years ago and see if we can clarify things a bit.
Many patients have said they were told by their doctors that the CDC had established fixed ceilings on opioid doses and that there was nothing the physician could do. In fact, what the CDC did was establish recommended dosage limits of 50 to 90 mg per day. But they did not prohibit doctors from prescribing more if they felt it necessary.
In addition, the guidelines are meant primarily for new patients. Longtime patients who have been receiving high doses without any issues are generally not targeted by the new guidelines. Although CDC does recommend broaching the possibility of dose reductions with those patients, doctors are not legally compelled to do so.
Since the new guidelines came into effect, some patients complain that they've been dropped by their pain management physicians because they failed a point-of-care drug test for this or that substance. But the fact is the new guidelines go out of their way to recommend against the practice of abandoning patients for any reason.
The point-of-care drug test is fairly common among pain management experts as it allows them to be sure their attempts to establish an effective treatment regime aren’t sullied by outside, illicit drugs. These tests are notoriously unreliable, however. But even when they are spot-on the CDC recommends patients who fail to not be dropped. So, if a physician claims a patient is being dropped for failing a drug test then that physician either doesn’t understand the new guidelines or something else is going on. But they’re not acting on the recommendation of the CDC.
This whopper can, in fact, be laid at the doorstep of the CDC whose guidelines suggest that opioid treatment is not necessarily the best way to treat severe or chronic pain. While there are any number of non-opioid meds that demonstrate various levels of effectiveness in dealing with some types of pain, most are virtually useless when it comes to the type of serious pain that can result from invasive surgery, serious accidents and injuries, cancer or other diseases and conditions.
Massage therapy, ibuprofen, acupuncture and more may all have their place, but there is simply no substitute for opioids when it comes to dealing with the intense, debilitating type of pain that can result from any of the above conditions. Anyone who tells you otherwise is simply mistaken. Still, some patients are being guided toward treatment methods that are either ineffective or counterproductive or both because of CDC guidelines which propagate the myth that alternative treatments can be just as effective as opioids.
If only this were so. But the fact is the guidelines established by the CDC in 2016 have had little if any effect on the opioid crisis. Any improvements that have been seen on the opioid front as a result of the new guidelines have been counterbalanced by the number of pain patients who feel they are no longer getting adequate treatment.
Truth be told, the opioid crisis is not being driven by medication given to and then resold by patients on the street. While there are certainly some cases of that, the fact remains that the bulk of street opioids are being smuggled into the US from China, Mexico and other countries where fentanyl is being produced in underground labs in huge quantities for the US market. So much illicit fentanyl is now on the streets, and it is so easy to obtain that some pain patients who are being denied medication by their physicians are now turning to street suppliers to provide them the relief they need.
While many of those in a position to prescribe opioids are curtailing the number, quantity and duration of those prescriptions in response to the CDC guidelines, they don’t have to. The guidelines themselves are nothing more than recommendations. Strong recommendations in many cases, but recommendations nonetheless. There are no punishments handed out for physicians who choose not to comply.
In fact, the CDC’s Debra Houry, who oversees the National Center for Injury Prevention and who helped draft the guidelines, clarified the situation in a letter to a concerned patient not long after the guidelines were released. In that letter she said that “the Guideline is not a rule, regulation or law” and the intention “is not to take away physician discretion and decision-making." That's pretty clear and doesn't leave any real wiggle room for those claiming that the guidelines are mandatory. So the next time your doctor tells you his or her hands are tied when it comes to prescribing opioids to help you deal with your pain, politely remind them that is not the case.
Anna is a content writer, blogger, and entrepreneur. When she is not spending time managing and supervising her business, Lindsley's Lumber, Anna creates content for her synthetic urine website. Aside from being an entrepreneur and blogger, she is also a pet lover, loves to cook and maintain her home garden. You can find out more about me here.