The U.S. Centers for Disease Control and Prevention (CDC) has issued a letter clarifying that people suffering from severe pain caused by cancer or sickle-cell anemia should not be denied prescriptions for opioid pain-killers.
The letter, which was issued on Tuesday, emphasizes that the guidelines restricting the use of opioid medications were not intended to apply to patients undergoing cancer treatment or to any patients suffering from chronic pain.
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In an attempt to curb the nation’s opioid addiction epidemic, some medical societies had called for physicians to limit their prescription of the potent painkillers.
The opioid epidemic is one of the most pressing public health issues in the United States today. Last year, more Americans died from drug overdoses than car crashes. And these overdoses have hit families across our entire nation.”
Sylvia Burwell, U.S. Health and Human Services Secretary
In 2016, the CDC released guidelines advising primary care doctors that in the majority of cases, opioids should only be prescribed as a last resort.
At the time, Thomas R. Frieden, Former Director of the CDC said, “The guideline was developed to support primary care clinicians who prescribe about half of all opioid pain medications in relieving patient’s pain, preventing patient’s suffering, and promoting patient’s well-being. This guideline helps by offering a flexible tool. Not a one size fits all tool…”.
Despite this, there was an unintended consequence; some insurance companies have refused to cover prescriptions for cancer patients/survivors and sickle-cell patients who are suffering with acute or chronic pain.
To estimate the impact of this outcome, the American Cancer Society sponsored surveys of cancer patients and survivors across the nation.
The results showed that the number of patients who were refused coverage for opioid prescriptions rose from 11% to 30% between 2016 and 2018. Furthermore, many more patients reported restrictions on how many opioid pills and refills they could have, as well as difficulty finding pharmacies prepared to fill the prescriptions.
Hematology society member Dr. Deepika Darbari, who treats young patients with sickle cell anemia reports that she has experienced insurers who refuse to cover IV opioids for patients experiencing severe pain, based on the CDC guidelines.
Now, the CDC has published a letter clarifying that the guidelines were never intended to deny such patients the painkillers, after three medical societies (the American Society of Hematology, the American Society of Clinical Oncology [ASCO] and the National Comprehensive Cancer Network [NCCN]) brought the problem to the agency’s attention.
The new clarification was issued to the societies in the form of a letter written by the lead author of the guidelines and top CDC medical officer Deborah Dowell.
This clarification from the CDC is critically important because, while the agency’s guideline clearly states that it is not intended to apply to patients during active cancer and sickle-cell disease treatment, many payers have been inappropriately using it to make opioid coverage determinations for those exact populations.”
Clifford Hudis, ASCO Chief Executive Officer
The CDC also stated that pain management in sickle cell anemia is complicated and that treatment approaches and reimbursement should be planned based on the guidelines that have been developed specifically for the disease.
Chief executive officer of NCCN, Robert Carlson, says the CDC’s letter will be made publicly available online and that it can be cited by physicians and patients if they experience problems with their opioid prescriptions being approved.
He also announced that NCCN has published recommendations to help cancer specialists evaluate the risk of opioid abuse “while still ensuring people with cancer don’t suffer unnecessary, severe pain.”
"The guidelines [that the] CDC is releasing today will provide safer pain management while helping us reduce opioid abuse. It’s an important step in our work to combat the opioid epidemic."