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Doctors and patients critical of CDC’s new opioid guidelines

Some 40 Americans are dying every day from prescription drug abuse.

In an effort to address the epidemic, the U.S. Centers for Disease Control and Prevention on Tuesday issued 12 recommendations for primary care physicians to abide by voluntarily. The CDC’s parameters are a follow-up to President Barack Obama’s instructions from his State of the Union address in January when he noted the far-reaching effects of opioid abuse.

According to the CDC website, increased prescribing and sales have quadrupled opioid use since 1999 and “helped create and fuel this epidemic.”

The guideline provides recommendations on the use of opioids in treating chronic pain (that is, pain lasting longer than three months or past the time of normal tissue healing). Chronic pain is a public health concern in the United States, and patients with chronic pain deserve safe and effective pain management. This new guideline is for primary care providers—who account for prescribing nearly half of all opioid prescriptions—treating adult patients for chronic pain in outpatient settings. It is not intended for guiding treatment of patients in active cancer treatment, palliative care, or end-of-life care.

CDC_prescription_drug_graphic reported that the guidelines could be widely adopted by hospitals, insurers and state and federal health systems.

Government officials have already tried multiple approaches to tackling painkiller abuse. The Food and Drug Administration restricted some widely-prescribed painkillers to limit refills. States like Florida and New York have cracked down on “pill mills” using databases to monitor what doctors are prescribing. And this week, Massachusetts signed into law a seven-day limit on first-time prescriptions for opioids — the first of its kind in the nation.

CDC director Dr. Tom Frieden said: “Changing medical practice isn’t quick and it isn’t easy, but we think the pendulum on pain management swung way too far toward the ready use of opioids.”

The recommendations—initially released earlier this year—have come under fire from many physicians on social media. For example, Dr. Stefan Kertesz, a primary care doctor trained in internal medicine and addictions, wrote on in January:

They [the CDC] urge aggressive use of urine drug testing to identify patients who take opioid medication differently from intended or use illicit drugs. In 56 pages, they say a lot more. My practice lines up closely with what this guideline recommends. And despite that, I feel the guideline is not yet ready, not given the regulatory power it will have.

Dr. Joseph Garbely, medical director at Caron Treatment Centers, a behavioral health and addiction treatment facility, wrote a few days ago that the CDC parameters put doctors in a “tenuous position.” If physicians refuse to prescribe an opiate, their patients might very well hop to another office until they get what they want and their continuity of care is broken, he said. “That’s why it’s critically important that the medical community play a significant role in creating meaningful change. Our goal as physicians must be eliminating irresponsible prescribing of opiates while allowing our patients’ pain to be appropriately treated. Primary care doctors are on the front lines of this epidemic but specialists have a role, too.”

Garbely also said medical schools and residency programs should mandate education about the recommendations as part of physicians’ maintenance of certification. 

[Free download: The Mayo Clinic, Piedmont Healthcare and Nebraska Medicine share best practices in health care internal communications.]

From the patient’s view

Providers aren’t the only ones to voice concern about the guidelines. People living with chronic pain offered insights about how the CDC parameters may affect them. Here’s a sampling from



In 2013, an estimated 1.9 million people abused or were dependent on prescription opiates, drugs in the same class as morphine.

Communicators, what are providers doing to address the opioid epidemic in their offices? Are you using social or traditional media to express opinions and educate the public?

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