After weeks of uncertainty, a federal advisory committee has endorsed controversial opioid prescribing guidelines that the Centers for Disease Control and Prevention proposed for physicians.
During a meeting late last week, the National Center for Injury Prevention and Control’s Board of Scientific Counselors unanimously supported the recommendation of a CDC expert working group, although the committee did suggest modifying some of the language.
“At this point, everything has been turned back over to CDC with the request for us to consider taking a closer look at the guideline recommendations where there were mixed opinions,” a CDC spokeswoman wrote us. Although she added the agency feels a sense of “urgency” about issuing its guidelines, there is no timetable for finalizing the proposal.
The meeting was held in response to criticism that the CDC draft guidelines were based on weak evidence and would unfairly restrict some patients from obtaining needed pain relief. The agency was also chastised for using a “secretive” process to formulate the guidelines, which some critics argued had violated federal law. As a result, the CDC delayed issuing the guidelines.
As we previously noted, the guidelines were assembled last year in response to a long-running epidemic of opioid abuse and misuse. Every day, 52 Americans die from overdoses of opioid painkillers. In response, the CDC convened a group of outside experts to draft guidelines for primary care physicians, since family doctors and internists write the vast majority of prescriptions for these drugs
The CDC guidelines suggest doctors prescribe opioids only after other treatments fail. The proposal also suggests doctors start patients on short-acting opioids — instead of extended-release, long-acting opioids — and initially prescribe the lowest possible effective dosage. The overall theme is to bolster physician awareness of abuse problems and encourage greater monitoring.
But some critics charged the guidelines will be far too restrictive and, consequently, make it difficult for some patients to be treated with the most effective options. Last month, the National Institutes of Health’s Interagency Pain Research Coordinating Committee held a meeting and then filed an objection to the CDC, prompting the National Center for Injury Prevention and Control’s Board of Scientific Counselors to review the guidelines.
It is worth noting that some critics who participated in the NIH committee meeting last month included patient groups that receive industry funding. Among them were the US Pain Foundation, the American Chronic Pain Association, and the Center for Practical Bioethics, all of which receive some funding from drug makers, including Purdue Pharma, which sells OxyContin.
In any event, one CDC expert working group member said the suggested changes appear to be minor.
“The tweaks to the wording resulting from these debates do not materially or contextually change the intent of the initial guideline recommendation. Most of the wordsmithing suggested here is neither surprising nor inappropriate,” said Dr. Lewis Nelson, an emergency medicine specialist at the New York University Langone Medical Center.
Meanwhile, one critic of the CDC proposal remains skeptical of the proceedings.
“They seem almost unchanged, which makes me think the ‘review of the review’ was strictly cosmetic and that the fix was in and it still is,” said Peter Pitts, a former Food and Drug Administration official who now heads the Center for Medicine in the Public Interest. He noted that the FDA also voiced objections to the guidelines. “It will be interesting to see if the guidelines are further modified.”