2016 guidelines from the Centers for Disease Control and Prevention inspired laws cracking down on doctor and pharmacy practices for prescribing Opioids.

In July 2016, the DWC Administrative Director adopted and incorporated by reference the Opioids Guideline (ACOEM April 20, 2017) into the MTUS from the ACOEM Practice Guidelines in its regulations § 9792.24.4.

The first CDC guidelines “put everybody on notice,” said Dr. Bobby Mukkamala, chair of the American Medical Association’s Substance Use and Pain Care Task Force. Physicians reduced the number of opioid pills they prescribe after surgeries, he said. The 2022 revisions are “a dramatic change,” he said.

In November, the CDC released new guidelines, encouraging physicians to focus on the individual needs of patients. While the guidelines still say opioids should not be the go-to option for pain, they ease recommendations about dose limits, which were widely viewed as hard rules in the CDC’s 2016 guidance. The new standards also warn doctors about risks associated with rapid dose changes after long-term use.

And in an advocacy letter to the CDC on the proposed new guidance, ACOEM said “ACOEM is appreciative of the opportunity to provide feedback to the Centers for Disease Control and Prevention (CDC) regarding its Clinical Practice Guideline for Prescribing Opioids – United States, 2022 and is supportive of many of the changes made to CDC’s original Opioids Guideline (2016) and the overall review process.” Nonetheless it continued to recommend restraint in the prescribing of opioids

But Kaiser Health News says that some doctors worry the new recommendations will take a long time to make a meaningful change – and may be too little, too late for some patients. The reasons include a lack of coordination from other federal agencies, fear of legal consequences among providers, state policymakers hesitant to tweak laws, and widespread stigma surrounding opioid medication.

“We had a massive opioid problem that needed to be rectified,” said Antonio Ciaccia, president of 3 Axis Advisors, a consulting firm that analyzes prescription drug pricing. “But the federal crackdowns and guidelines have created collateral damage: patients left high and dry.”

Taking into account the perspective of chronic pain patients, the latest recommendations try to scale back some of the harms to people who had benefited from opioids but were cut off, said Dr. Jeanmarie Perrone, director of the Penn Medicine Center for Addiction Medicine and Policy.

“I hope we just continue to spread caution without spreading too much fear about never using opioids,” said Perrone, who helped craft the CDC’s latest recommendations.

Christopher Jones, director of the CDC’s National Center for Injury Prevention and Control, said the updated recommendations are not a regulatory mandate but only a tool to help doctors “make informed, person-centered decisions related to pain care.”

Dr. Stefan Kertesz, a professor of medicine at the University of Alabama-Birmingham said the new CDC guidance reflects “an extraordinary amount of input” from chronic pain patients and their doctors but doubts it will have much of an impact if the FDA and the Drug Enforcement Administration don’t change how they enforce federal laws.

Even for people with prescriptions, it’s not always easy to get the drugs they need. Pharmacy chains and drug wholesalers have settled lawsuits for billions of dollars over their alleged role in the opioid crisis. Some pharmacies have seen their opioid allocations limited or cut off, noted Ciaccia, with 3 Axis Advisors.

The new CDC Guidelines have yet to be incorporated into the ACOEM Guideline or the Workers’ Compensation MTUS.