CDC weighs removing dosing limits for opioids | Boston


BOSTON — Federal health officials are considering a plan to update restrictions on opioid prescribing as pain management groups push for changes to help people with chronic illnesses get their medication.

The U.S. Centers for Disease Control and Prevention is finalizing new federal clinical practice guidelines on opioid prescribing that will remove recommended ceiling on opioid doses and urges physicians to use “non-opioid therapies” to treat chronic and acute pain, such as physical therapy, yoga and acupuncture.

The draft guidelines, once finalized, would be the first major revision of the federal agency’s opioid prescribing guidelines in more than five years.

Pain management groups, which have aggressively pushed to update the CDC’s 2016 prescribing guidelines, said they see progress in revisions to the rules.

“Those guidelines caused egregious harm over the years,” said Cindy Steinberg, chairwoman of the policy council with the Massachusetts Pain Initiative, an advocacy group. “People were forcibly weaned off their medication and had withdrawals. There are even reports of some people committing suicide.”

Steinberg said the regulatory backlash in response to the opioid epidemic made physicians reluctant to write prescriptions for opioids. As doctors cut back on prescribing, patients who suffer from chronic and acute pain have struggled.

The CDC’s 2016 guidelines recommended a limit of 90 morphine milligram equivalents daily for chronic pain patients, which caused an uproar.

While the dosage limits were only recommendations, at least 33 states adopted them and many physicians applied them as rigid standards.

“These reason those guidelines were so controversial was because they were arbitrary,” Steinberg said. “They really weren’t based on clinical evidence.”

While Steinberg said she is encouraged by the CDCs decision to remove the specific dosing limits for opioid painkillers, and other changes in the proposed update, she’s not sure if the changes will make much of a difference.

“Frankly, doctors are still too afraid to prescribe those medications at this point,” she said. “It’s going to be very hard for things to change significantly.”

In 2019, the Food and Drug Administration issued an advisory to physicians not to abruptly stop opioid medications for patients who are physically dependent on them.

The advisory followed reports of patients with “serious withdrawal symptoms, uncontrolled pain, psychological distress and suicide,” the agency said.

Last year, the American Medical Association wrote to the CDC, urging the agency to update its “problematic guideline” on opioid prescriptions that has “proved devastating for patients with pain.”

“We know that this has harmed patients with cancer, sickle cell disease, and those in hospice,” the physicians group wrote. “The restrictive policies also fail patients who are stable on long-term opioid therapy.”

While Massachusetts wasn’t among the states that adopted the CDC’s dosing limits, it nevertheless has imposed some of the strictest opioid prescribing laws in the nation in response to a wave of overdose deaths in recent years.

In 2016, Gov. Charlie Baker and lawmakers pushed through a raft of rules to curb over-prescribing. Those included a cap on new prescriptions in a seven-day period and a requirement that doctors consult a state prescription monitoring database before prescribing an addictive opioid.

The restrictions appear to have produced results. Data released by state health officials show opioid prescriptions in Massachusetts have declined 40% since 2016. In 2020, providers wrote 33.3 opioid scripts for every 100 residents, according to the CDC, the lowest rate in New England.

Despite the drop in prescriptions for pain medications, opioid-related overdose deaths increased in Massachusetts during the pandemic.

There were 2,104 confirmed and suspected opioid-related deaths in Massachusetts in 2020 — a 5% rise over the previous year, according to the state Department of Public Health.

Nationally, opioid-related overdose deaths soared to a record 93,000 last year.

While substance-abuse counselors say the roots of addiction for many start with a prescription for opioids, pain management groups point out that majority of the overdose fatalities in recent years have been attributed to fentanyl — a deadly synthetic opioid — not prescription pain pills.

The CDC is soliciting public input on the new opioid prescribing rules before they are finalized, which is expected to happen by the end of the year.

As of Thursday, the Federal Register had received nearly 3,000 comments on the proposed guidelines, many of from chronic pain patients who say strict prescribing restrictions and stigma about opioids are preventing them from getting their medicine.

Kimberly Wohead, a nurse and pain suffer from Arizona, said she has been “belittled, labeled or discriminated against” for taking pain medication.

“We must allow for responsible practitioners to have the autonomy to treat and manage chronic pain without some governmental entities breathing down the patient or the specialists neck,” she wrote. “It is time for responsible, reasonable legislation that does not punish those individuals who take their medication properly and responsibly.”

Christian M. Wade covers the Massachusetts Statehouse for North of Boston Media Group’s newspapers and websites. Email him at cwade@northofboston.com.



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