WASHINGTON, DC (Circa) - The Center for Disease Control (CDC) published guidelines on opioid prescribing in 2016, but some doctors think it is time to re-examine the guidelines because they say they might have been influenced by inaccurate data.
"It was obvious from the get-go that they were inflating the numbers, and for whatever reason seemingly overestimating the number of opioid deaths," said Dr. Dan Laird, pain management physician and medical malpractice attorney in Las Vegas.
According to a recent article written by CDC officials in the American Journal of Public Health, death certificate data does not always differentiate between illegally and legally obtained drugs, so a fatal overdose involving illicitly manufactured fentanyl could have been counted as a legal opioid prescription death.
Because of this, the total deaths from prescription opioids would have appeared to be over 32,000 in 2016, but the numbers were probably closer to about 17,000, and the CDC said they changed their method of calculating these deaths in 2015 to account for the increased availability of illicit fentanyl.
"It is vital to understand the changing landscape of the opioid overdose epidemic and distinguish between the impact of different types and sources of opioids. The changes in calculation are a result of the evolving epidemic," CDC official Puja Seth and co-author of the article told Circa in an email.
But Dr. Laird and other pain management physicians do not think the CDC has been as transparent as the agency appears.
"CDC really needs to do a complete mea culpa and say we really screwed up," said Dr. Michael Schatman of Boston Pain Care and Tufts University School of Medicine.
Dr. Laird said the agency's use of inflated numbers have created a “hysteria” about prescription opioids, and he and Dr. Schatman both think it is time for the CDC to re-examine their guidelines on opioid prescribing because of this.
"The CDC guidelines have created an environment where it is basically okay to criticize chronic pain patients, they are now second or third class citizens," Dr. Laird said.
The guidelines are not strict rules that doctors have to follow, but Dr. Laird said they have influenced laws and regulations restricting doctors on dosage and length of opioid prescriptions.
"Legislatures across the country are now enacting these Draconian anti-opioid laws based on the hysteria that the CDC has whipped up and it has been extremely detrimental,” Dr. Laird said.
Dr. Schatman agrees, and said these laws have hurt those in the chronic pain community.
"I'm concerned from a bio ethical perspective about the patients out there now who can't get medications, who are committing suicide, or just suffering so needlessly when nothing else is available for them," Dr. Schatman said.
Dr. Mark Sullivan is a psychiatrist at the University of Washington Medical Center for Pain Relief and he disagrees that the possibly overestimated numbers have created “hype” about prescription opioids.
"The only issue is we misclassified some fentanyl deaths as prescription deaths rather than illicit opioid deaths. That’s possible, but that does not mean that there has been hype,” Dr. Sullivan said. “That does not mean that the guidelines are misconceived.”
He said the number of fatal overdoses related to illegal drugs might be on the rise, but the problem still stems from prescription opioids, so there is no need to change the guidelines.
“It doesn’t change the riskiness and dangers associated with opioids. We all know that the deaths are shifting more towards illicit opioids. They are more dangerous, but the fact remains that the vast majority of people dying from illicit opioids started on prescription opioids," said Dr. Sullivan.
Overall, Dr. Laird said reducing the number of prescription opioids is a good thing, but should not be forced upon all patients.
“Medicine should be a collaborative relationship between the patient and the doctor where they are both doing what is in the best interest of the patient, and often that is reducing opioid dose. I would agree that opioids should be used only as a last resort and in the lowest effective dose, and certainly opioids are not indicated for many chronic painful conditions, but for some they are.,” Dr. Laird said.