More than just CDC opioid guidelines need to change – Pain News Network


By Roger Chriss, PNN Columnist

The CDC’s preliminary revisions to its 2016 opioid guideline are generally seen as an improvement by pain management experts because they give doctors more flexibility in prescribing opioids. But how much will the prescription really change?

According to EMS1an online resource for emergency medicine providers, states are likely to resist making changes to their own opioid regulations.

“For the relaxed guidelines to have the desired effect, states should amend or repeal existing laws that limit opioid prescriptions to three to seven days and set caps on the daily dose that physicians can prescribe,” reported EMS1.

The reasons are simple. Amid a deteriorating drug overdose crisis and complex prescribing landscape, proposed changes in CDC guidance are likely to be seen at the state level as a net negative for public health. . States have a jumble of opioid prescribing regulations and changing them won’t be easy.

“Relaxing these regulations now would wreak havoc on states. They won’t know what to do,” says Gary Franklin, MD, who is vice president of regulatory affairs for the state Physicians for Responsible Opioid Prescribing (PROP), an anti-opioid activist group.

“We’ve made a dent in the use of prescription painkillers,” Franklin told EMS1. “But we still have a lot of work to do.”

Lewis Nelson, MD, chair of emergency medicine at Rutgers New Jersey Medical School, is concerned about plans to drop the guideline’s recommended dose limit of 90 milligram equivalents of morphine (MME) per day. Nelson says the “watered down recommendations” will lead to more addiction and overdoses.

“By removing this recommended cap … prescribers may feel it is appropriate to prescribe longer initial prescriptions for their patients,” Nelson said. The Daily Targum, a Rutgers student newspaper. “It was one of the key factors that created the opioid crisis in the early 1990s that has lasted until today.”

Federal agencies and states are doing their own thing

Because they are controlled substances, prescription opioids are not regulated in the same way as other medications. Manufacturing levels are determined by the DEA, which annually determines opioid production quotas based on contributions from the FDA, CDC, Centers for Medicare and Medicaid Services (CMS), and individual states. The DEA has been steadily cutting prescription opioid production quotas for nearly a decade and it seems unlikely to change course anytime soon.

Drug approval rests with the FDA, which says one of its “highest priorities” is to reduce the number of Americans dependent on opioids. “This can be achieved by ensuring that only appropriately indicated patients are prescribed opioids and that prescriptions are for durations and doses that correctly match the clinical reason for which the drug is prescribed in the first place,” says the FDA on its website.

Federal programs such as Medicare, Medicaid, and VA/Tricare, as well as private insurers and pharmacies, exert considerable influence on clinical practice through formularies, guidelines, and prior authorizations.

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