The Survey Says…the CDC Opioid Guideline Needs to Be Honestly Assessed

The Survey Says...the CDC Opioid Guideline Need to Be Honestly Assessed by Lynn R. Webster @LynnRWebsterMD

One-Year Anniversary of the CDC Opioid Prescribing Guideline

On the one-year anniversary of the Centers for Disease Control and Prevention’s (CDC) opioid prescribing guideline, an online survey of patients, doctors, and healthcare providers conducted by Pain News Network and the International Pain Foundation (iPain) found that the guideline has “harmed pain patients, reduced access to pain care, and failed to reduce drug abuse and overdoses.”

You’ll recall that the CDC Guideline for Prescribing Opioids for Chronic Pain provided “recommendations for primary care clinicians who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care.” The emphasis is mine. The goal, as stated by the CDC’s web site, was to improve “… the way opioids are prescribed through clinical practice guidelines” and to “ensure patients have access to safer, more effective chronic pain treatment while reducing the number of people who misuse, abuse, or overdose from these drugs.”

CDC Recommendations or Mandates?

The CDC meant well by drafting these recommendations. However, there has been broad recognition and adoption of the guideline as policy. This wasn’t the intention of the guideline.

On August 24, 2016, soon after the CDC had shared its guideline, then-U.S. Surgeon General Vivek H. Murthy “took historic action by sending a personal letter to more than 2.3 million health care practitioners and public health leaders.” In that letter, he asked these physicians and thought leaders to pledge to “turn the tide” of opioid addiction, and he touted the CDC guideline as a “good place to start.” In other words, his letter suggested that cutting back on the number of opioid prescriptions was a priority for ending the opioid epidemic.

Pain News Network and iPain Surveys Chronic Pain Patients

Just as the Pain News Network and iPain survey reported that patients are finding it increasingly difficult to receive the opioid prescriptions they need to manage their pain, The Centers for Medicare and Medicaid Services (CMS) took matters a step further “by mandating [the guideline] as official Medicare policy and taking punitive action against doctors and patients who don’t follow them.” Bob Twillman, PhD, Executive Director of the Academy of Integrative Pain Management, commented in Pain News Network: “When CDC released its guideline, many feared that policymakers and payers would quickly move to convert CDC’s voluntary recommendations into mandatory regulations, which appears to be coming true, both with CMS and with private payers.”

The results of the survey are not surprising. According to Anson’s article, since the “voluntary” implementation of the CDC’s guideline a year ago, “…over 70 percent of pain patients say they are no longer prescribed opioid medication or are getting a lower dose. While reducing opioid prescriptions may have been the ultimate goal of the guideline, it came with a heavy price: Eight out of ten patients say their pain and quality of life are worse. Many are having suicidal thoughts, and some are hoarding opioids or turning to illegal drugs for pain relief.”

Assessment of the CDC Opioid Prescribing Guideline

The guideline has had far-reaching effects. It would seem any policy that affects as many people as the opioid prescribing guideline has should be assessed to determine the impact it’s had — especially since it is poised to become mandatory rather than voluntary. Assessment should include the number of opioid-related overdose deaths, number of ER admissions for opioid-related overdoses, and the number of people admitted for treatment of opioid use disorder since the guideline’s introduction, and how that compares with the numbers before the guideline was introduced.

Perhaps there should also be an estimate of the economic windfall to payers because of the fewer opioids prescribed to patients. After all, the payer community was involved in developing the CDC opioid prescribing guideline.

Most importantly, there should also be an assessment on the impact the guideline has had on patients’ access to adequate pain management. Unfortunately, it doesn’t appear any such assessment is planned.

Based on the results of the survey and hundreds of emails I have received; it may be appropriate for the CDC to invite the pain community to help revise the guideline to create a public heath policy that strikes a better balance of avoiding opioid-related problems while allowing opioids to be used in a responsible way. The proper use of opioids, under any public health policy, should be determined by clinicians who treat people in pain and informed by their patients’ individual needs.

Finally, any guideline that is proposed without acknowledging the needs of people in pain runs the risk of worsening the opioid problem and causing people who are in pain to suffer more than they must. It is time for the CDC to assess the impact the guideline has had for people in pain and to act on their findings.

Purchase my book, The Painful Truth: What Chronic Pain Is Really Like and Why It Matters to Each of Us (available on Amazon), or read a free excerpt here.

The Painful Truth @lynnrwebstermd Lynn R. Webster

Find me here:

Amazon and Facebook

Copyright 2017, Lynn Webster, MD



  1. Tricia Salese on March 20, 2017 at 3:22 pm

    I follow you religiously. I fear that your comment will fall on deaf ears: “it may be appropriate for the CDC to invite the pain community to help revise the guideline to create a public heath policy that strikes a better balance of avoiding opioid-related problems while allowing opioids to be used in a responsible way.” The pain community was grudgingly invited the first time around, but not given a voice/say in the construct of this guideline because the CDC pursued some very clear goals with this “guideline”.
    1) Paint all opioid use as evil. In their effort to raise awareness of an opioid epidemic, they missed the true cause of this epidemic and nothing beyond reducing opioid prescribing was ever considered.
    2) Paint doctors as scapegoats.
    3) Give the DEA MORE power/funding.
    4) Give folks like Kolodny and other people who run “addiction treatment centers” a financial windfall.

    I could go on and on and you will not find being considerate of pain patients among any of the CDCs goals.

    Thank you Dr. Webster for continuing to fight for us.

  2. Dorlee on March 20, 2017 at 3:38 pm

    I just sent an e-mail to a group called “I am Essential”. They are trying to stand up for the rights of patients and their access to medical care, prescriptions etc. during this repeal of Obama care. There are approx. 200 groups signing their letter. I just asked them if they could help us, the chronic pain community. Who knows, I have tried everywhere else. Does anyone else out there think that maybe there are two many pain groups? Do they get together? For instance, that survey we all signed regarding Medicare adopting CDC rules was only signed by approx. 3400 folks. I know there are a lot more of us than that. How do we all get together? Maybe a group of thousands of voices would be stronger than many small groups of 100-?

    • Kara on March 23, 2017 at 8:31 pm

      @Dorlee, I agree! We are all too spread apart & need a way to bring all the support groups together.

      I just have no idea how to do it. I have a FB pg Chronic Pain Reform and a group by the same name with the group having just been made.

      Sadly, I find most groups don’t like to share members, info, and the such. As if they all want to be the one group that single handedly resolved our plight.

      I wish with all my heart that we could join forces. I myself will not be able to exist this way much longer.

      I was doing well. I was happy. Now? My life is 96% non-functional, unhappy, depressed, I wake with anxiety attacks every day, and feel like there’s really no point to it all any more. I was working my way toward independence. I had been teaching myself a new trade and trying to build a home based business. But now, I find it nearly impossible to shower, to get out of my pj’s, to feed the cat, to shop for food (in fact many times I go hungry b/c even though I’m out of food I just cannot walk through a store and stand in line), and other basic chores that life requires.

      I am so sorry there’s an “Opioid Crisis” but I just cannot wrap my head around why the life of an addict, who at one point chose their path, is worth mote than my life!? I did not choose my gene pool not did I force certain illness/disease genes to become expressed between the ages of 11 and 47 yrs of age!

      Where is my right to life? Who cares rather I live or die? Apparently no one. These are the new Dark Ages.

    • Becky on April 9, 2017 at 10:39 am

      Letters in numbers!!

      I belong to a group called chronic pain voices. I agree with getting all chronic pain patients together!
      .. just a thought !

      if every chronic pain patient wrote a letter to president Trump for help.
      Whether it is a hand-written sentence, or a perfectly formatted letter, such as
      ‘ I am a chronic pain patient and I need help.’

      President Trump
      White house
      Most important at the
      Left bottom corner envelope
      Chronic Pain Patient Help

      Of course just a rough draft of wording- I’m convinced there would be an impact?

  3. Concerned about the Stigma and Repercussions from speaking the Truth on March 20, 2017 at 3:46 pm

    The problem with the CDC, and all the believers of the CDC guidelines, is the false assumption that ALL the BLAME lies in this fantasy of “aggressive overprescribing”. So the totally erroneous belief that simply lowering the number and amount in opioid prescriptions would have an effect on addicts, and addiction. This is completely false, and absurdly so. First, the problem does not lie in ‘aggressive overprescribing’, as prescribing has gone down SO MUCH that the DEA has lowered manufacturing by 25%. Doctors are overwhelmingly dropping out of prescription and pain management fields, ERs are going “opioid less”, dentists, pharmacies are not carrying them, insurance is not paying for them, and on and on. Lowering prescriptions will not ‘stamp out addiction’. Addictive behavior is not tied in with prescribing medicines. Addicts are addicts, and they will continue to act as addicts with ANY SUBSTANCE! Patients ARE PATIENTS and it doesn’t matter if you place 1 pill or 100 pills in front of them, they do not exhibit addictive behavior. Not now, not in one year, not if they are given ‘more than 90’. Because it simply DOES NOT WORK THIS WAY.
    Second, if the vast MAJORITY of patients prescribed opioid analgesics do NOT display ANY abuse, addictive, adverse events and behaviors WHY the push to LOWER their dosages and frequencies? The rational explanation would be if the patient is obviously harmed by the medication, therefore a need to lower or remove the medicine. In some cases, more is not better…hence, the ‘Practice of Medicine”. I might need 10mgs every 4 hours, whereas you might need 5 mg every 6 or 8 hours, and we both might need different medicines. We will have to take them over an extended period of time in order to MANAGE our medical conditions and ailments. If 1 pill would magically cure me or take away ALL the symptoms, then that would be great, but this is not the case, far from it. These medications , for the chronically ill, need to be taken several times a day , pretty much every day, and pretty much for the rest of our lives, until they have come up with a magical ‘cure’ for chronic pain.
    Leaving patients in pain, because addicts are overdosing on heroin is so lacking in logic, is so inhumane, barbaric, and idiotic in nature, that pain patients are still reeling in shock, horror, and in awe of the stupidity in so ineptly trying to address this problem.
    Again, pain patients, who are stable, do well, do not show signs of side effects, no aberrant behavior, no abuse, no diversion…nothing…are STILL being told they are doing something wrong, illegal, immoral, irresponsible, vice like, and more. They are the patients, yet they bear all the stigma, discrimination, ire, condescension, blame , and shame. If they are not being harmed, you cannot justify pulling their medicines in order to satisfy some imaginary phenomena, OR think that removing or reducing a legitimate pain patient’s opioid analgesic will somehow cure addiction and stop addicts from addictive behavior, and use heroin. And when people say that “prescription painkillers are the gateway to heroin”, they conveniently leave out that yes, some addicts have used prescription opioids prior to moving onto heroin….BUT NOT PRESCRIBED PAIN MEDICINES. You cannot blame a legitimate pain patient who is prescribed these medications meant only for severe chronic pain, because an addict STOLE , or BOUGHT them off the street, and COMBINED them with other drugs which is what addicts tend to do.
    I am not responsible for an addict’s behavior and possible overdose or crimes because they broke into my home and stole my medicines and then abused and misused them or sold them to someone else. I am not responsible because an addict who has no pain or medical conditions , bought some pills from a drug dealer. I live in the United States, here we are “Innocent until proven guilty”. Yet this is happening to me, and MILLIONS of other pain patients.
    So when they say “Prescription Painkillers” the public thinks “PRESCRIBED pain killers”, thus further maligning and slandering innocent pain patients. And the CDC helped start this wave, supported by all the other alphabet agencies, the media, insurance companies, and everyone and their grandmother is now convinced “those pills will get you addicted!” because they are “legal heroin!”. Sure, opioids don’t come from a plant and are synthesized from the extracts of a plant that is all natural. Oh wait…yes they are. Also, they have been use since at least the 1940s and 1950s. But NOW all of a sudden , people are overdosing on heroin, so we have to BLAME the ‘painkillers”.
    Sure, at one time, many years ago there were ‘pill mills’. But not today.
    Today we have heroin and the street ‘Fentanyl’ from China. Even the CDC said they ‘overstated the role of pain killers in the (so called) epidemic”. What do you think that means? it means there was a recognition that some mistakes were made.
    But the wave of anti opioid medicine and pain patient STILL continues. Strange huh?
    We have identified that 1) it is not prescribed pain patients that are the problem after all 2) there IS no ‘aggressive overprescribing; 3) “pill mills” are all but gone nowadays 4) study after study repeatedly shows that the incidence of abuse among patients has NEVER been more than 3% maximum. We have been using these medicines for DECADES now. 5) the problem is heroin, not prescription painkillers. As the pills have mostly dried up. These pills are between $50 to $80 per pill! a bag of heroin is around $10. What do you think is happening?
    Yet still we have the entire glut of agencies, the media, insurance groups and everyone else still proclaiming that “dependence” on a medication to treat and manage your illnesses IS ‘deviant behavior’, and is the SAME THING as ‘addiction’.
    Do we say this to a person with Diabetes when they are dependent on their daily insulin?
    Do we say this to a person with Hypertension when they are dependent on their daily blood pressure medication?
    or the person with Alzheimer’s? Strokes? HIV? and on and on and on? They ARE ALL ‘dependent’ on their medications?
    And many will have some ‘withdrawal’ symptoms if their medication was suddenly stopped.
    We have a huge amount of incredibly ignorant , yet over zealous people from every field against these medications , doctors who prescribe them, and the pain patients who need them. It seems that no matter how many studies, statistics, and data we show to all of them, they don’t change their mind. Instead, many of these, whom curiously are attached to abuse recovery centers….consider us all ‘addicts’. And there is a push to place these pain patients instead on addiction managing opioids, very expensive, and addiction centers owned by these anti opioid zealots too. Interesting dont you think?

    • Jodi on March 22, 2017 at 12:20 am

      100 % accurate!! As a chronic pain patient I totally feel like I am judged and feel like I need to always explain why I have to take them. I’m 41 years old and feel like my parents scold me for my medical problems because they watch the news and think now I’m going to suddenly start heroin because I have pain medication for multiple issues, but mainly because I had a knee replacement that got infected and I’ve had 5 surgeries to try to fix it, and they haven’t fixed it. I have stabbing pain in that leg that even with my pain meds still wakes me up during the night. I’ve never even smoked a cigarette before. Thank you for posting exactly my same thoughts.

  4. Laura Taylor on March 20, 2017 at 6:48 pm

    I think thats the most right on statement ive read yet! We are treated terribly and there no sight of reality settling in anytime soon. They turn a blind eye to oyr suffering, petitions, emails or phone calls. They are unwilling to even acknowledge the truth!

  5. Joanne Ward on March 21, 2017 at 2:12 am

    I still believe the Dr.s need be more careful on who they give the meds to and not take away from the patients that have been on it long term!

    I’ve been in pain over 25 years and on pain meds over 20 years. They almost killed me. I had enough problems with this certain clinic and this Dr. wanted to take me off cold turkey.

    You see, I can come of it but the reprocussions are terrible. I’m also a diabetic and have intestinal problems so I take klonopin. I’ve been put in intensive care too many times for that very reason. They would not let me stay on it long enough to see a pain specialist. Plus I take pain meds for a hip problem.

    The pain specialist was wise enough to keep me on both. One was decreased but now I get shots in my hips. I still cannot walk very far.

    I was premed. I’m ashamed how Dr.s are being manipulated by people that don’t understand. They are told what to do and cannot make up their own minds. They should keep track of Dr.s that give too much and then go through their paperwork and patients. Also check the reasons they’re getting it, their age, etc. I had a 13 year old patient with bone cancer and they refused to give her pain meds before her x-rays. I refused to sit with her after a certain amount of time because of the pain she was in. I got in trouble for taking her back to her room. The next morning she had died. Do you think she understood the Dr.s rules? NO!

    I’ve been sick my whole life. Believe me, I have a living will and will not let me suffer any longer than need be.

    One thing-you cannot stop a drug addict. Dr,s need to watch out for them. But Dr.s also must look out for patients telling the truth and make sure they can live some sort of life. I can’t get disability because they say I don’t LOOK sick yet I can’t work and rely on a son for food. How would you like to live like that!

    One rule cannot cover everyone.

  6. Joanne Ward on March 21, 2017 at 2:25 am

    I do agree totally with the person that put up “Concerned about the Stigma and Repercussions from speaking the Truth says”.

    But what really bothers me now are all the commercials that warn you you’ll have problems with constipation if you take pain meds! You NEVER saw that before all this started. Like that is going to change our minds if we really need it! You’re talking to the wrong people!

    There are other commercials that say different things too, that are very inappropriate to be putting on tv. It will not help.

  7. Steven Pitkin on March 23, 2017 at 5:43 pm

    As a Vietnam Veteran who’s been dealing with chronic pain it hurt me to find that there are more that 1200 (reported) cases of VA Employees who have been stealing pain killers, sedatives and other pills to increase their standard of toy buying while the same institution has lumped us along with those who use the medications to get high on. We sign contracts, and in the last year the VA was at the forefront in drastically lowering our dosages “cold turkey”. While Administrators steal taxpayer money, get “fired and rehired” by the VA, in reading their response to the theft by VA employees, the VA underplays the issue and says they are going after people who do this.
    The only thing that changes at the VA is the intensity of the pain one endures.

  8. Scott michaels on April 1, 2017 at 6:59 pm

    Were all SCREWED!!!
    SO THE INSURANCE COMANIES CAN SAVE A BUCK WITH NO CONCERN FOR US. KAISER and medicare have no compassion and should be audited and sued for malpractice

  9. Kate on May 1, 2017 at 2:53 am

    Unfortunately, I don’t see the CDC changing anything. They are getting what they wanted when they instituted these guidelines and are not about to change it (unless it means limiting needed pain medication even further).
    While these guidelines were supposed to apply only to primary care physicians, and to acute pain that is not what happened.
    Pain patients will continue to suffer at the hands of a governmental agency that has no right inserting themselves into the doctor/patient relationship.

Leave a Comment