Will the New CDC Opioid Prescribing Guidelines Help Correct the Course in Pain Care?

This Medical News article discusses the 2022 Clinical Practice Guideline for Prescribing Opioids for Pain, an update to widely criticized recommendations released by the CDC in 2016.

Economic stressors and the enactment of CDC-recommended COVID-19 prevention behaviors: The impact of state-level context.

In order to combat the spread of the novel coronavirus, the Centers for Disease Control and Prevention (CDC) has developed a list of recommended preventative health behaviors for Americans to enact, including social distancing, frequent handwashing, and limiting nonessential trips from home. Drawing upon scarcity theory, the purpose of this study was to examine whether the economic stressors of perceived job insecurity and perceived financial insecurity are related to employee self-reports of enacting such behaviors. Moreover, we tested propositions regarding the impact of two state-level contextual variables that may moderate those relationships: the generosity of unemployment insurance benefits and extensiveness of statewide COVID-19-related restrictions. Using a multilevel data set of N = 745 currently employed U.S. workers nested within 43 states, we found that both job insecurity and financial insecurity were negatively related to the enactment of the CDC-recommended guidelines. However, the state-level variables acted as cross-level moderators, such that the negative relationship between job insecurity and compliance with the CDC guidelines was attenuated within states that have a more robust unemployment system. However, working in a state with more extensive COVID-19 restrictions seemed to primarily benefit more financially secure workers. When statewide policies were more restrictive, employees reporting more financial security were more likely to enact the CDC-recommended guidelines compared to their financially insecure counterparts. We discuss these findings in light of the continuing need to develop policies to address the public health crisis while also protecting employees facing economic stressors. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Data protection during the coronavirus crisis.

Smartphone apps to track SARS-CoV 2 infections need to fulfill certain minimal requirements to guarantee privacy and justify their use under data protection laws.

Race/Ethnicity-Resolved Time Trends in United States ASD Prevalence Estimates from IDEA and ADDM.

Race-specific time trends in Autism Spectrum Disorder prevalence are tracked among 3-5 year-olds and 8 year-olds identified by the U.S. Individuals with Disabilities Education Act (IDEA) and the Autism and Developmental Disabilities Monitoring (ADDM) Network, respectively. White ASD prevalence historically has been higher than other racial groups but plateaued for IDEA birth cohorts from ~ 2004 to 2007 before resuming its increase. Black and Hispanic IDEA prevalence increased continuously and caught up to whites by birth year ~ 2008 and ~ 2013, respectively, with black prevalence subsequently exceeding white prevalence in the majority of states. Plateaus in white prevalence occurred in some ADDM states for birth years 2002-2006, but IDEA trends suggest prevalence will increase across all racial groups in ADDM's birth year 2008 report.

Opioid discontinuation as an institutional mandate: Questions and answers on why we wrote to the Centers for Disease Control and Prevention.

On March 6, 2019, a self-designated committee sent a public letter to the Centers for Disease Control and Prevention (CDC) urging the agency to address the widespread misapplication of its 2016 guideline on prescribing opioids. Three hundred and eighteen health care professionals, and three former Directors of the White House Office of National Drug Control Policy (Drug Czars) signed the letter, as did the parent organization for Substance Abuse Journal, the Association for Multidisciplinary Education and Research on Substance use and Addiction. The letter reflected concern about a wide range of initiatives and policies by payers, quality metric agencies, health care organizations, and other regulators enforced to strongly incentivize or mandate forced opioid dose reductions on long-term opioid recipients who were otherwise stable. In April of 2019, both the United States Food and Drug Administration and the CDC's Director issued statements that could help to reduce ongoing harms resulting from such forced reductions, provided they are taken seriously. This commentary explains the rationale for the original letter, and the optimum course of action now that the CDC has responded.

Management of Chronic Pain in Adults Living With Sickle Cell Disease in the Era of the Opioid Epidemic: A Qualitative Study.

Importance: The hallmark of sickle cell disease (SCD) is vaso-occlusive pain that may be acute and episodic or may progress to chronic, persistent pain with unpredictable and disabling exacerbations. Patients with SCD rely on opioids almost exclusively for acute and chronic pain management. Objective: To understand how the current opioid epidemic and subsequent guidelines from the Centers for Disease Control and Prevention are associated with the management of acute and chronic pain for patients with SCD. Design, Setting, and Participants: Qualitative study using semistructured interview guides. Interviews 1 hour or longer were conducted over the telephone. Participants were adults (aged ≥18 years) diagnosed with SCD who experienced pain on 3 or more days per week recruited from national SCD conferences, symposiums, and 2 sickle cell clinics. Open coding analysis facilitated thematic analysis of interview transcripts. Data collection took place from May 2017 to June 2018. Main Outcomes and Measures: Participant perspective of any changes to their pain management associated with the 2016 guidelines from the Centers for Disease Control and Prevention. Results: The 15 adults interviewed had a median (range) age of 32 (21-52) years; 13 (87%) were female; and all were of African American race/ethnicity. Participants reported that recently their opioid prescriptions had become more restrictive, were more closely monitored, and were increasingly difficult to fill in pharmacies. Participants also described increased stigmatization about opioid use and that their medical care was being affected by the physician's exclusive focus on reducing pain medication use. There was an emerging interest among adult patients in the consideration of the use of alternative therapies, including marijuana, to manage pain. Conclusions and Relevance: These findings suggest that from the perspective of adults living with SCD, the opioid epidemic may have negatively affected patients' care by increasing barriers to opioids. Patients reported decreased opioid dosing, increased stigmatization regarding opioid use, physician preoccupation with opioid dosage interfering with comprehensive care, and lack of access to alternative therapies.

Perspectives on the opioid crisis from pain medicine clinicians.

Patients experiencing a terminal drug related event reflect a sentinel event. If this pharmacotherapy is a widely used agent, it may be viewed as a catastrophic problem. If patients are dying from illegal drug use when the medical establishment fails them by withdrawing or minimizing their medically prescribed medication, then the burden rests with their health care providers, legislation, and insurance carriers to actively participate in a collegial fashion to achieve parity. Causing a decay in functionality in previously functional patients, may occur with appropriately prescribed opioid medications addressing non-cancer pain when withdrawing or diminishing either with or without patient consent. The members of the medical profession have diminished their prescribing of opioids for their patients out of apparent fear of reprisal, state or federal government sanctions, and other concerned groups. Diminishing former dosages or deleting the opioid medication, preferably in concert with the patient, often results in inequitable patient care. Enforcing sanctioned decreases or ceasing to prescribe from their former required/established opioid medications precipitate patient discord. In absence of opioid misuse, abuse, diversion or addiction based upon medical "guidelines" and with a poor foundation of Evidence Based Medicine the CDC guidelines, it may be masked as a true guideline reflecting a decrement of clinical judgment, wisdom, and compassion. This article also discusses the role of pharmacy chains, insurance carriers, and their pharmacy benefit managers (PBMs) contribution to this multidimensional problem. There may be a potential solution, identified in this paper, if all the associated political, medical and insurance groups work cohesively to improve patient care. This article and the CDC guidelines are not focused at hospice, palliative, end of life care pain management.