The CDC response
Press release
FOR IMMEDIATE RELEASE APRIL 10, 2019
TWO FEDERAL AGENCIES SPEAK AGAINST MANDATED OR PRECIPITOUS OPIOID REDUCTIONS IN CHRONIC PAIN PATIENTS
Contacts: Health Professionals for Patients in Pain: www.healthprofessionalsforpatientsinpain.org
Stefan G. Kertesz, MD skertesz@uabmc.edu and Sally Satel, MD slsatel@gmail.com
On April 10, the Director for the Centers for Disease Control and Prevention, Dr. Robert Redfield, wrote to Health Professionals for Patients in Pain (HP3) to state that the CDC’s 2016 Guideline offered no support for mandatory opioid dose reductions in patients with long-term pain. Coming on the heels of an April 9 warning from the United States Food and Drug Administration of “serious harm” to patients after rapid dose reduction or discontinuation, the Director’s letter flags the need for a recalibration of care decisions imposed by a wide range of private and governmental agencies that have invoked the CDC to justify coverage restrictions, quality metrics, legal threats and other actions to force dose reductions on nonconsenting patients.
The CDC Director’s letter was sent to all five members of HP3, which had asked him to “boldly” clarify his agency’s 2016 Guideline on prescribing opioids for chronic pain. He has done this. His agency is also evaluating the impact of the Guideline on clinical practice.
In their March 6 letter to Dr. Redfield, signed by 3 former United States “drug czars” along with 318 other health care professionals, the authors cited “draconian” opioid dose reductions due to misapplication of the Guideline, resulting in widely-reported harms to patients.
The CDC’s Director’s April 10 response specified that:
1. Cautionary dose thresholds from the CDC’s 2016 Guideline had been intended to apply only for “initiation” of opioids, rather than for the care of longstanding recipients who were stable at higher doses.
2. Clinicians must “work with patients to taper or reduce dosage only when patient harm outweighs patient benefit of opioid therapy.”
3. For patients already receiving doses higher than 90 morphine milligram equivalents, “the recommendations include reviewing the risks and benefits of continuing high-dosage therapy, and if a patient would like to taper, collaborating with the patient on an individualized plan.”
The director attached a 3-page review of the CDC’s current projects to evaluate the Guideline’s impact.
“There remains an urgent need to confront an addiction crisis where prescriptions were a key part of its genesis. But I have seen many patients harmed by widespread misapplication of the Guideline,” said coauthor Dr. Stefan Kertesz, a scholar in addiction medicine at the University of Alabama at Birmingham, who has opposed quality metrics and payment policies that incentivize dose reductions without protection for patient safety.
“We are so grateful to the CDC for its essential clarification,” explained Dr. Sally Satel of the American Enterprise Institute and Yale University. “Now it’s time for the federal, state, and non-governmental institutions that have invoked the CDC’s authority to push some traumatic changes to care to reverse course.”