Oversight on Revision of US CDC Opioid Guidelines: A Process Pre-Destined to Fail
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In December 2019, the US Centers for Disease Control and Prevention (CDC) announced their intention to review and revise 2016 Guidelines on Prescription of Opioids to Adults. CDC solicited nominations for an advisory “Opioid Workgroup” to report to the Board of Scientific Counselors of the National Center for Injury Prevention and Control within CDC.
This presentation reviews issues identified in the final Workgroup report of July 2021, compared with revised and expanded guidelines of November 2022. Workgroup input to the CDC was largely marginalized or ignored in revised guidelines. The guidelines contain multiple crippling misconceptions that are so glaringly obvious that writers and reviewers could not possibly have been unaware of them before publication.
▪ Guidelines mandate individual risk-versus-benefit analysis for each patient before employing opioid therapy for acute or chronic pain. But no viable analytic framework is offered for performing such analysis.
▪ Guidelines grossly over-emphasize risk, ignoring evidence from multiple sources that incidence of iatrogenic opioid
addiction is so low that it cannot be reliably measured. Addiction is not a predictable outcome of prescribing and is known to be rare in clinical settings.
▪ Guidelines fail to address a 25-year medical literature on effects of genetic polymorphism in the human liver, causing wide variation in minimum effective opioid dose and side effects. This literature invalidates all previous published trials of prescription opioid effectiveness.
▪ Guidelines recommend without evidence that non-pharmaceutical and non-opioid therapies are “preferred” over opioids. However, no published trials directly compare non-pharmaceutical therapies to opioids.
From the evidence it is clear that US CDC should be removed from all further participation in development of public policy for the treatment of severe pain.
Keywords: Pain management, Practice guidelines, CDC, Risk analysis, Addiction
Abbreviations: CDC: Centers for Disease Control and Prevention
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