AMA urges revision to opioids guideline

June 22, 2020

The organization presented recommendations to stop the guideline from harming patients.

The American Medical Association is calling on the Centers for Disease Control and Prevention (CDC) to make revisions to the 2016 Guideline for Prescribing Opioids for Chronic Pain in order to protect patients from the unintended consequences and misapplication of the guidance.

In a June 16 letter to the agency, AMA Executive Vice President and CEO James L. Madara, MD, called for the arbitrary limits and other restrictions on opioid prescribing to be removed as they have increased stigma for patients with pain and resulted in legitimate care being denied. He also noted that the CDC cautioned against misapplying the guidelines to justify specific dose or quantity restrictions.

“To make meaningful progress toward ending this epidemic, a broad-based public health approach is required,” wrote Madara. “We are now facing an unprecedented, multi-factorial and much more dangerous overdose and drug epidemic driven by heroin and illicitly manufactured fentanyl, fentanyl analogs, and stimulants. We can no longer afford to view increasing drug-related mortality through a prescription opioid-myopic lens.”

The letter lists concrete examples of how the guideline has been used to implement policies which have not been shown to improve pain care or reduce opioid-related harms while payers continue to build and reinforce barriers to non-opioid pain care options.

One of the recommendations listed in the letter is to increase the use of these non-pharmacological pain care options by fundamentally altering and aligning public and private payer policies to support payment for these treatments and developing evidence to inform clinical decision-making on using these approaches as well as training more physicians in their effective use.

Other recommendations in the letter include:

  • Emphasizing that decisions about continuing, tapering, or discontinuing opioid therapy should be made by the patient and their doctor
  • Explicitly stating that hard thresholds for prescribing opioids should never be used and any policies which implement thresholds based off the CDC guideline should be eliminated,
  • Removing specific timelines for patient monitoring in favor of timelines determined by the physician and patient.