The Centers of Disease Control (CDC) has developed guidelines on the use of opioids for pain management that some insurers and pharmacists have used to restrict providing these medications to patients in need.  They need to be discouraged from this practice, according to members of the American Medical Association (AMA) House of Delegates.“This is a recognition that there are many patients we deal with daily who are outside the norms proffered by the CDC guidelines,” said Bob Wailes, MD, of Rancho Santa Fe, California, a delegate for the American Academy of Pain Medicine. “The gist of this proposal is that the CDC guidelines have gone way too far and have been used as strict legislative and pharmacy benefit limitations.  We need to recognize by policy that there are patients who fall outside the guidelines.”Delegates approved a compromise that commends the CDC for “its efforts to prevent incidence of new cases of opioid misuse, addiction, and overdose deaths” but also encouraged the AMA to talk to pharmacists, state insurers, and state medical boards about issues associated with placing limits across patient populations on the amount and dosage of prescribed opioids.  Stakeholders such as pharmacists and insurers need to be aware of the benefits of making modifications when necessary.

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“The AMA Opioid Task Force has discussed these issues extensively,” said Frank Dowling, MD, of Islandia, New York, a delegate for the New York state medical society. “We’re getting feedback from physicians around the state...with physicians being punished, prescriptions not being filled, and patients left without medications. It’s extremely harmful – these medicines do work and care [needs to be] individualized.”Delegates also passed several provisions offered by Chad Kollas, MD, of Orlando, on behalf of the American Academy of Hospice and Palliative Medicine, including one that asked the AMA to confirm that there are certain patients who benefit from taking higher doses than suggested.Another provision called for the AMA to advocate that “no entity should use MME (morphine milligram equivalents) thresholds as anything more than guidance, and physicians should not be subject to professional discipline, loss of board certification, loss of clinical privileges, clinical prosecution, civil liability, or other penalties or practice limitations solely for prescribing opioids at a quantitative level above the MME threshold found in the CDC guideline for prescribing opioids.”“As family physicians, we strongly believe in patient-centered care,” said Romero Santiago, MD, MPH, of Sacramento, a resident delegate for the American Academy of Family Physicians. “It’s important for us not to have a standard on MME equivalents...It’s important to advocate for the needs of our patients.”Scott Pasichow, MD, of Warwick, Rhode Island, a resident delegate for the Massachusetts Medical Societ asked that the MME provision be referred to the board of trustees.  He added, “MMEs are part of Rhode Island state law right now, so there are places where a practice like this is enacted; I would just want more information on the effects of that being positive or negative on our patients as well as us as providers, before we come to the decision that we oppose this as anything more than guidance.”Arlene Seid, MD, an alternate delegate for the American Association of Public Health Physicians, also agreed. “I work for a regulatory agency and the issue is, sometimes guidances are used to take in drug dealers, especially those of us who do not adhere to good practice,” she said. “I ultimately would be supportive of this [provision] properly crafted, but [for now] I would be in favor of referral.”“Great to see the AMA is finally stepping up to help bring common sense to the ill-conceived and frankly very harmful CDC guideline,” added Lynn Webster, MD, past president of the American Academy of Pain Medicine. “Unfortunately too many people have already been a victim of CDC’s misguided attempt to address the opioid problem.”

Sources:

AMA Delegates Back Physician Freedom in Opioid PrescribingAMA: ‘Inappropriate Use’ of CDC Guideline Should Stop