NORMAN J CLEMENT RPH., DDS, NORMAN L.CLEMENT PHARM-TECH, MALACHI F. MACKANDAL PHARMD, IN THE SPIRIT OF WALTER R. CLEMENT BS., MS., MBA., BELINDA BROWN-PARKER, IN THE SPIRIT OF JOSEPH SOLVO ESQ., INC.T. 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., WALTER F. WRENN III., MD., JULIE KILLINGWORTH, LESLY POMPY MD., CLINTON BATTLE, JR., CHRISTOPHER RUSSO, MD., NANCY SEEFELDT, WILLIE GUINYARD BS., JOSEPH WEBSTER MD., MBA, BEVERLY C. PRINCE MD., FACS., NEIL ARNAND, MD., RICHARD KAUL, MD., 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 NJOKU, BS., RPH., IN THE SPIRIT OF DEBRA LYNN SHEPHERD, BERES E. MUSCHETT, STRATEGIC ADVISORS
EVALUATION AND ASSESSMENT
BY RICHARD LAWHERN, PH.D.
US CDC has released their Clinical Practice Guideline for Prescribing Opioids. Like its predecessor draft in February of this year, it doubles down on lies and cherry-picked research intended to further suppress opioid prescribing at the expense of under-treating patients and driving clinicians out of pain management practice.
Specifically in Recommendation 4:
Many patients do not experience benefits in pain or function from increasing opioid dosages to ≥50 MME/day but are exposed to progressive increases in risk as dosage increases.
Therefore, before increasing total opioid dosage to ≥50 MME/day, clinicians should pause and carefully reassess evidence of individual benefits and risks. If a decision is made to increase the dosage, clinicians should use caution and increase the dosage by the smallest practical amount.
The recommendations related to opioid dosages are not intended to be used as an inflexible, rigid standard of care; rather, they are intended to be guideposts to help inform clinician-patient decision-making.
• Additional dosage increases beyond 50 MME/day are progressively more likely to yield diminishing returns in benefits for pain and function relative to risks to patients as dosage increases further.
Clinicians should carefully evaluate a decision to further increase dosage on the basis of individualized assessment of benefits and risks and weighing factors such as diagnosis, incremental benefits for pain and function relative to risks with previous dosage increases,
CDC releases the 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain
The 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain (2022 Clinical Practice Guideline) is now available in the Morbidity and Mortality Weekly Report (MMWR), published on November 3, 2022. The publication updates and replaces the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain. CDC also released a suite of tools and resources to helppatients and clinicians understand and use the recommendations in the new Guideline in their pain care decision making.
The 2022 Clinical Practice Guideline is a clinical tool to improve communication between clinicians and patients and empower them to make collaborative and informed, patient-centered decisions related to pain care. It provides recommendations for clinicians providing pain care, including those prescribing opioids, for adult outpatients with acute, subacute, and chronic pain. Importantly, the Guideline’s recommendations do not apply to pain management related to sickle cell disease, cancer-related pain treatment, palliative care, or end-of-life care. It is meant to be a flexible clinical tool and should not be used as a rigid standard of care or one-size-fits-all policy or law.
Separately:
Opioid therapy is associated with similar or decreased effectiveness for pain and function versus NSAIDs across multiple common acute pain conditions (10). Opioid therapy is associated with small improvements in shortterm (duration of 1 to <6 months) pain and function compared with placebo, with increased short-term harms compared with placebo, and with evidence of attenuated pain reduction over time (between 3 and 6 months versus between 1 and 3 months) (10). Evidence exists from observational studies of an association between opioid use for acute pain and long-term opioid use (10). Evidence on long-term effectiveness of opioids remains very limited (7); a long-term (12 months) randomized trial of stepped therapy for chronic musculoskeletal pain found no difference in function and higher pain intensity after starting with opioid therapy compared with starting with nonopioid therapy (74). Evidence exists of increased risk for serious harms (including opioid use disorder and overdose) with long-term opioid therapy that appears to rise with increase in opioid dosage, without a clear threshold below which there is no risk (7).
Richard “Red” Lawhern Ph.D.:
Thus, both MMED thresholds and false claims of one-size-fits-all dose thresholds are alive and well in this final draft. More than ever, I am convinced that the CDC must be restricted by law from issuing practice guidelines of this type.
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