CDC Recommendations on Opioids for Chronic Pain

We're facing a chronic pain epidemic in America. For decades, people suffering from chronic pain from fibromyalgia or other painful conditions have wondered, "When is the medical establishment going to pay real attention to us?" Now they are, but you might not like the result.

Bottle of pills
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The CDC is advising doctors on how to treat chronic pain, and the cornerstone of the recommendation is this: opioid painkillers are not recommended for long-term use. They have good reasons for that recommendation, but that doesn't mean it won't cause additional suffering in people who are already suffering more than enough. The specific drugs we're talking about here include:

The term "opioid" refers to synthetic versions of opiate drugs. They're also frequently referred to as narcotics.

The Crux of the Opioid Issue

At the heart of the problem is that we're also experiencing an epidemic of painkiller abuse and overdose deaths. In fact, drug overdose is now the leading cause of accidental death in the US, and opioids are a major reason for that. According to the American Society of Addiction Medicine:

  • More than 47,000 people died of drug overdoses in 2014;
  • Nearly 19,000 of those deaths were due to prescription painkillers;
  • Nearly 11,000 more were attributed to heroin (more on this below);
  • Unintentional opioid deaths have quadrupled since 1999;
  • As legal opioid sales have increased, addiction treatment and overdose deaths due to opioids have paralleled them.

Why look at heroin deaths alongside those of pain medication? Heroin is an opioid too, and in surveys, as many as 94 percent of heroin addicts say they first became addicted to prescription painkillers then switched to heroin because it's cheaper and easier to get. Heroin usage and overdose deaths have climbed at a similar rate to prescription opioid addiction and death.

When faced with those numbers, the proliferation of opioid prescriptions is suddenly alarming. It's a public health and law enforcement crisis that must be addressed. That's why the CDC is looking at how opioids are prescribed and looking for alternatives.

Chronic Pain and Inadequate Treatment

Meanwhile, we have more and more people living with constant pain. The National Institutes of Health (NIH) in 2015 said that the "one-pill-fits-all" approach was inadequate and pushed for more use of non-drug treatments that were evidence-based, individualized, and involved multiple types of treatment.

At the same time, the NIH has publicly stated that the medical community as a whole isn't familiar enough with non-drug treatments, which makes it easy to rely on opioids. Many people living with chronic pain can attest to the truth of the NIH's statements. That may be because their treatment only involves painkillers and is inadequate.

It can also be because they've explored other options and found more relief than with the pills alone. However, even among those who've found other effective treatments, opioids often continue to play a role in their regimen.

Additionally, people with poorly understood conditions like fibromyalgia often find that their doctors can't give them adequate guidance on what to do other than taking medications, and those medications often include opioids.

The Trend Away From Opioids

Because opioids do help a lot of people function better, the chronic pain community has reacted with fear and anger as the government and law enforcement have tried to crack down on opioid misuse.

When pain doctors started being investigated and some lost their licenses, other doctors became too scared to prescribe opioids. Who can blame them? No one wants their livelihood threatened.

Then, in 2014, the Drug Enforcement Administration moved hydrocodone to the controlled substance list, from Schedule III to Schedule II, which made patients jump through new hoops in order to get prescriptions filled, including getting a new prescription from the doctor every time and needing to take a physical prescription into the pharmacy instead of having the doctor fax it.

This created additional hardship, especially for people who have to drive a long way to their doctor's office and/or pharmacy.

Pain patients and advocates have called for the government and law enforcement to find ways of combatting the problem without depriving people of medication that they rely on. However, that doesn't seem to be what they're getting.

At the same time, chronic pain is a massive issue that needs to be properly addressed. According to the National Pain Report:

  • 100 million Americans suffer from chronic pain,
  • Pain costs the US about $600 billion a year,
  • More people have chronic pain than have diabetes, heart disease or cancer.

The CDC's Recommendations

In the spring of 2016, the CDC published its Guideline for Prescribing Opioids for Chronic Pain. It details the problems opioids are causing, lays out non-drug and non-opioid treatment options, and the evidence (or rather, lack thereof) that opioid use is effective for chronic pain.

The guideline lays out 12 points for doctors to follow when prescribing opioids for chronic pain. It includes how to determine whether opioids are appropriate for the individual patient, how to weigh benefit vs. risk, what should be discussed with the patient, how to safely maintain opioid treatment, and how to watch for addiction and how to treat it appropriately.

When considering the risks – both to the individual and to society – these 12 points are sensible and responsible. If a doctor reads the entire, very long report, he or she will see what kinds of evidence-based treatments are suggested, including:

  • Physical therapy
  • Cognitive behavioral therapy
  • Exercise therapy
  • Steroid injections.

When it comes to non-opioid drugs, the CDC mentions:

  • Anti-inflammatory drugs like ibuprofen
  • Anticonvulsants such as pregabalin and gabapentin
  • Antidepressants.

On the surface, the CDC's recommendation makes sense. Why prescribe a dangerous drug to a lot of people when it's not helping them that much and is causing a major public health crisis?


Doctors should be approaching pain in a more individualized, comprehensive way. However, until the medical community is better educated about non-drug approaches, this can't happen in any meaningful way.

The full CDC report is extremely long. If a doctor looks at the summarized 12 points at the end, they won't see any of the other recommendations. Some may see the first line—"Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain,"—and stop there.

This sounds like a harsh indictment of doctors. It's not intended that way. Doctors are busy and may not have time to go through the guidelines with a fine-toothed comb. Plus, while some doctors are wonderful, some are mediocre, and some are downright awful.

Pain patients, and especially those with poorly understood conditions like fibromyalgia, all too often hear things like, "We don't have drugs that work very well for that, so you just have to learn to live with it."

Other Perspectives

Pain patients and advocates have long called for sensible regulations that address the problems with minimal impact on those who use these drugs legitimately. At some point, they argue, you have to listen to the patient.

For example, in a study, doctors may not consider the amount of improvement significant while to the person in pain, that small improvement is the difference between being somewhat productive and staying in bed all day, or between making it through a day of work and having to go on disability.

A common argument is that a very small number of pain patients become addicted to opioids, with one study showing that it only happens in about 3 percent. When you eliminate those with a history of drug abuse or addiction, the rate falls to below 0.2 percent.

Additionally, they urge more focus on the illegal ways in which many addicts or drug dealers get their opioids, such as:

  • Stealing or creating fake prescription pads
  • Illegal internet purchases
  • Stealing from pharmacies, hospitals or medical centers
  • Impersonating medical personnel and calling in refills.

The opioid issue is a complex and critically urgent issue. Perhaps someday the problem will be diminished enough that pain patients won't feel like they're being unjustly targeted and losing access to medications they need.

In the meantime, it pays for pain patients to be educated on the issues—and the guidelines—so we can make sure our doctors are using them correctly and not interpreting them as a "don't prescribe opioids" mandate.

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