BY
NORMAN J CLEMENT RPH., DDS, NORMAN L.CLEMENT PHARM-TECH, MALACHI F. MACKANDAL PHARMD, BELINDA BROWN-PARKER, IN THE SPIRIT OF JOSEPH SOLVO ESQ., IN THE SPIRIT OF REV. C.T. VIVIAN, JELANI ZIMBABWE CLEMENT, BS., MBA., IN THE SPIRIT OF THE HON. PATRICE LUMUMBA, IN THE SPIRIT OF ERLIN CLEMENT SR., WILLIE GUINYARD BS., JOSEPH WEBSTER MD., MBA, BEVERLY C. PRINCE MD., FACS., LEROY BAYLOR, JAY K. JOSHI MD., MBA, ADRIENNE EDMUNDSON, ESTER HYATT PH.D., WALTER L. SMITH BS., IN THE SPIRIT OF BRAHM FISHER ESQ., MICHELE ALEXANDER MD., CUDJOE WILDING BS, MARTIN NDJOU, BS., RPH., IN THE SPIRIT OF DEBRA LYNN SHEPHERD, BERES E. MUSCHETT, STRATEGIC ADVISORS
“THE IMPORTANCE OF DEPRIVING ONE OF KNOWLEDGE IS AN UNEDUCATED POPULATION IS MUCH MORE EASIER TO CONTROL”
“We Are Licensed Physician, Pharmacists, Healthcare Providers Not Drug Dealers”
FROM: CDC Office of the Chief of Staff
TO: WALTER F. WRENN III., MD.
AUGUST 31, 2021
Dear Dr. Wrenn:
Thank you for contacting the Centers for Disease Control and Prevention (CDC) regarding the CDC’s
CDC’s mission is to protect the health and safety of all Americans. CDC is committed to supporting patient care and safe and effective pain management options. The purpose of the CDC 2016 Guideline is to support clinicians and patients to work together to create and maintain safe, consistent, and effective personal treatment plans. The recommendations in the CDC Guideline are voluntary, rather than prescriptive standards.
The Guideline includes practical information and provides recommendations about the appropriate prescribing of opioids to improve pain management and patient safety. The inclusion of morphine milligram equivalents (MME) thresholds such as 90MME are not intended to serve as hard limits, but rather as benchmarks to assist clinicians in assessing the risks and benefits to patients and weighing factors such as diagnosis, other treatments, effectiveness, and recommendations based on consultation with pain specialists.
The Guideline does not recommend abrupt, involuntary, or rapid opioid dose reduction or discontinuation to physicians. As noted in the Guideline, such actions can result in patient harm, including withdrawal symptoms, damage to the clinician-patient relationship, and patients obtaining opioids from other sources. The Guideline emphasizes that clinicians have a responsibility to carefully manage opioid therapy and not abandon patients.
Although many providers, health systems, quality-improvement organizations, payers, and states have made efforts to improve opioid prescribing practices and reduce opioid misuse and overdose, CDC recognizes that some policies and practices that cite the Guideline are inconsistent with, and go beyond, its recommendations.
Guideline for Prescribing Opioids for Chronic Pain — the United States, 2016 (Guideline,
www.cdc.gov/mmwr/volumes/65/rr/pdfs/rr6501e1.pdf).
On April 24, 2019, CDC published a commentary in the New England Journal of Medicine, “No Shortcuts to Safer Opioid Prescribing.” In the commentary, the authors outline examples of misapplication of the Guideline and highlight sections from the Guideline that are sometimes overlooked but are critical for safe and effective implementation of the recommendations, including misapplication of recommendations to populations outside the Guideline’s scope; misapplication of the Guideline’s dosage recommendation that results in hard limits; and misapplication of the Guideline’s duration recommendation that results in ‘cutting off’ opioids or abrupt tapering.
CDC is not a regulatory agency and does not mandate or require implementation of the Guideline. Regardless of specialty, no one is required by CDC to follow the Guideline. This is true for both pain clinics and primary care providers. The Guideline is intended to help clinicians provide safe and effective pain management treatment for their patients, including prescribing opioids when the benefits of opioids outweigh the risks. The Guideline is not a regulation or law, but rather a set of recommendations for primary care providers. The recommendations in the Guideline are voluntary and are intended to support informed clinical decision-making in the context of the provider-patient relationship.
The Guideline emphasizes that doctors should consider the circumstances and unique needs of each patient when providing care. Patient safety is our top concern, and CDC encourages providers and patients to carefully consider both the benefits and serious risks of these medications in making decisions about chronic pain management. Some patients may be on an appropriate opioid therapy for their situation, and that should be considered as part of their care plan. Clinical decision-making should be based on a relationship between the doctor and patient, and an understanding of the patient’s clinical situation, functioning, and life context.
The Guideline is not intended to take away physician discretion and decision-making, but it is designed to help physicians assess how to safely maintain or discontinue opioid use in patients who are currently on an opioid treatment plan or start opioids safely if necessary. CDC is updating the Guideline and carefully considering how Guideline recommendations are framed and written to ensure proper application and to avoid misinterpretation. Information on the specific Guideline recommendations, risks and benefits, and other topics are located here for your reference:
https://www.cdc.gov/opioids/providers/prescribing/clinical-tools.html
We appreciate your interest in this important public health issue and hope you find this information helpful.
Sincerely,
Sandra Cashman, MS
Executive Secretary Office of the Chief of Staff, CDC
FOR NOW, YOU ARE WITHIN
THE NORMS
Guideline Resources, Provider and Partner Tools:
https://www.cdc.gov/opioids/providers/index.html
Clinical Tools for Providers:
More information on the specific Guideline recommendations:
https://www.cdc.gov/opioids/providers/prescribing/guideline.html
