The Centers for Disease Control and Prevention (CDC) has been at the center of a controversy brewing over updated prescribing guidelines for physicians. The CDC guidelines offer recommendations for primary care physicians who prescribe opioid painkillers to patients with chronic pain problems. This has been an area of concern for the CDC and other national public health figures for some time. In fact, Thomas Frieden, the director of the CDC recently stated that “Addressing the prescription overdose epidemic has become one of the CDC’s top priorities.” Central to the debate over the draft CDC guidelines is the need to weigh risks versus benefits for patients.
Understanding the Guidelines and their Potential Impact
The CDC guidelines were drafted by a group of experts in pain medicine and related fields. The experts reviewed scientific evidence about the use of opioid painkillers as well as guidelines promoted by other organizations. They distilled this evidence into draft guidelines intended to help primary care physicians navigate their decisions about prescribing opioids to patients.
The draft CDC guidelines soon became the source of great controversy. On one side of the debate are patients, who worry that the guidelines may make it more difficult for them to obtain opioid medications needed to control their chronic pain. On another side are public health officials concerned about statistics showing that rates of prescriptions for opioid painkillers are up 300% since 1999. Still others are concerned that pharmaceutical companies, or other special interest groups, are exerting undue influence on what is intended to be an objective, scientific process of determining best practices for opioid prescribing.
Results of a Patient Survey about the Draft CDC Guidelines
In response to the the draft of the CDC guidelines, many patients have grown concerned about access to prescription opioids. In a survey of more than 2,000 American adults with acute or chronic pain, patients expressed their concern about the draft guidelines. Of the respondents, more than 80% currently take a prescription opioid medication.
The respondents showed split opinions about the scope of the opioid prescription problem. Only 3% said that they “strongly agree” that opioid medications are overprescribed, with 35% saying that they “disagree” and 23% reporting that they “strongly disagree.” Approximately 1 in 4 people were unsure about the scope of the opioid overprescribing issue.
The survey respondents also expressed concern about their ability to obtain opioids if the CDC guidelines are adopted. Nearly 70% said they were “very worried” about being able to get prescription opioids, while another 20% were “somewhat worried.” This speaks to the large number of Americans who currently depend on opioid medications for pain relief. One of the CDC guidelines encourages physicians to discuss alternative pain management strategies with patients. This includes discussing the risks and benefits of opioid medications versus other scientifically-validated approaches to pain relief.
Remarkably, many survey participants stated that they are concerned about the negative impact of the draft CDC guidelines on patient well-being. Approximately 38% of people thought that overdoses might actually increase, while just 5% agreed with the CDC that the guidelines would help to combat the prescription opioid overdose problem. At the same time, a majority of survey respondents expressed concern that more people will suffer, use of heroin will increase, and there will be more suicides. This speaks to the enormous concern of patients with pain problems about their ability to achieve effective pain management.
Although the CDC guidelines recommend alternative forms of pain management, many survey participants reported that they received little or no benefit from over-the-counter pain relievers (76% of respondents), non-opioid prescription drugs such as antidepressants (52%), or behavioral interventions such as weight loss or exercise (64%). Additionally, many insurance plans do not cover treatments such as acupuncture or massage. This limits patients’ access to these potentially beneficial non-pharmacologic interventions.
Taken together, the survey indicates widespread patient mistrust about the draft CDC guidelines. With the guidelines temporarily put on hold pending further review by an expert panel, it remains to be seen how these guidelines will impact physician prescribing practices or patient experiences.
CDC, Draft CDC Guideline for Prescribing Opioids for Chronic Pain, Retrieved on January 18, 2016.