As providers consider the opioid prescribing guidelines being proposed by the Centers for Disease Control and Prevention, one of the issues is whether labeling them as voluntary means doctors would not be bound to them.
The CDC developed the guidelines in response to the growing number of opioid overdose deaths being recorded throughout the country. They suggest trying alternative therapies when possible and small quantities and dosages when opioids are used. They also recommend urine testing to determine patient compliance.
In a meeting of the Board of Scientific Counselors of the National Center for Injury Prevention and Control, the CDC Thursday requested a new work group to review the guidelines. Their release was postponed after doctors and patient advocates complained of a lack of transparency. Comments on the guidelines are being accepted until Jan. 13.
The CDC has emphasized that it is not a regulating agency, and the guidelines are voluntary and intended for primary-care doctors treating patients with chronic pain. Physicians, however, have said they expect the guidelines to be adopted by licensing boards and other entities.
A letter from the American Cancer Society spells out the concerns that the guidelines would quickly become far from voluntary.
“Guidelines officially sanctioned by the CDC are likely to have significantly greater impact than guidelines promulgated by other organizations,” officials wrote. “In fact, the CDC imprimatur makes it more likely that these guidelines become de facto requirements through adoption by state health departments, professional licensing bodies or insurers.”
There is also worry that the guidelines could be used against doctors in legal cases.
Dr. Michael Wilson, a medical malpractice attorney in Washington, D.C., said malpractice cases vary greatly in details, but doctors can in some instances be held accountable for a patient becoming addicted to or overdosing on opioids.
Lawyers would look at whether the diagnosis called for an opioid prescription as well as whether the patient's history and physical status were properly vetted, he said.
Guidelines published by the CDC, even if they are described as voluntary, could be used to determine whether a doctor followed the national standard of care, he said.
“Anything put out by the CDC is pretty impressive,” he said. “It would be pretty good evidence.”
Dr. Asokumar Buvanendran, an anesthesiologist and professor at Rush University Medical Center in Chicago, said he expects various professional groups will adopt the guidelines, and physician practices may say doctors should be using them when prescribing.
He said the guidelines are “reasonable clinical practice,” but doctors were concerned that they were developed without their input or patient input. He said he isn't concerned about the guidelines becoming a liability issue.
“I think it would be more of a tool,” he said.