The CDC (Centers for Disease Control and Prevention) has created an Opioid Prescribing Guidelines draft. The drafted guidelines were kept secretive until the CDC hosted a webinar for select groups recently. Among the groups included were: CVS Caremark (the pharmacy chain); health insurance companies, such as Kaiser Permanente and Blue Cross Blue Shield; and the Substance Abuse and Mental Health Services Administration (SAMHSA). The group not included was one of the most important - the patient. I support having those companies having some input, but not the only input. What about patients and pain patient advocates? There are only a couple to a handful of patient representatives that were invited to the webinar.

What's worse is that there seems to be a rush to get these guidelines in place, with the CDC wanting to submit them in early November to the U.S. Department of Health and Human Services, and hoping to have them published in January 2016.

Now that they have been released to physicians, some doctors have put the guidelines in place. I hope you will join me in encouraging the CDC to make some changes to the opioid guidelines prior to finalizing them.

Please find the summary of guidelines at http://www.cdc.gov/drugoverdose/prescribing/guideline.html

A full list is not available on the CDC's website, but it is at http://www.painnewsnetwork.org/stories/2015/9/16/cdc-opioids-not-preferred-treatment-for-chronic-pain

I will also summarize some of the guidelines for you.  

• Strict dose amounts/limits are set.
• Medication types are recommended.
• "Providers should prescribe short-acting opioids instead of extended-release/long acting opioids."
• Suggestion that "Three or fewer days will usually be sufficient for non-traumatic pain not related to major surgery."
• There were conflicts of interest with regard to the “Core Expert” panel the CDC used to write the guidelines. For instance, some of the members are against using opioids for any pain that is not cancer pain. How can they be neutral when writing the guidelines?

I am a chronic pain patient. I am in favor of having guidelines for physicians, as long as they are reasonable and do not put patients at risk, which is not the case here. For instance, physicians will be urged to use non-pharmacological and non-opioid therapy for chronic pain. It concerns me that the guidelines have a type of medication suggested (Naloxone), that there are dose amounts/limits (avoid 90 mg), there are guidelines for everything except tapering or weaning off an opioid, and that there are “additional precautions” mentioned, but not listed.

As far as the webinar goes, the CDC put out word of the webinar at the last minute, no one was allowed to ask questions during the webinar, if you made a suggestion, apparently, they did not respond to you. Also, the webinar will not be made available to the public because the recording was for archive only. I have also heard that many people that did catch wind of the webinar and successfully logged in, had technical difficulties after participating for a very short time and either could not continue or had to start all over.

I am afraid that with all the secrecy and the rush, that there are many items that are not safe or that could cause problems for chronic pain patients. Now the government will be making medical decisions for patients? Is that really the change that is needed? Why not take a step back, allow representatives from all affected groups to review and comment, and get the guidelines right?

Please urge the CDC and the U.S. Department of Health & Human Services to rethink the guidelines and to include the people whose lives are going to be affected day after day because of the guidelines.