How the CDC’s opioid rules created a crisis for chronic pain patients

Perhaps the most powerful argument against the CDC opioid guideline did not come from patient advocates, pain specialists, professional organizations, data reviews, surveys, or modeling studies. In December 2018, Human Rights Watch, an international organization with staff in 40 countries, best known for exposing torture by totalitarian regimes, published a hundred-page investigative report of the effects of the CDC opioid guideline. The report detailed a harrowing series of accounts of persons with undoubted severe chronic pain whose lives had been turned into hell by involuntary opioid dosage reductions or discontinuances prompted by the CDC opioid guideline. One provider, who insisted on anonymity, summarized: “It promotes an absolute culture of fear.”

Human Rights Watch wrote to CDC asking, “Is the CDC aware that in multiple states, its recommendations have been written into law and/or used by insurers, state medical boards, or other enforcement bodies as a mandate for physicians? Does the CDC believe that this is appropriate?” CDC gave no answer to these questions, merely reiterating in an anonymous response that “the recommendations in the guideline are voluntary.” Voluntary was an unusual choice of adjective, since the guideline specified that most of its recommendations applied “to all persons” with no “individual decision making needed.” Human Rights Watch concluded that the situation could be considered a violation of basic human rights since the United Nations Special Rapporteur on health and torture had specified that “the de facto denial of access to pain relief, if it causes severe pain and suffering, constitutes cruel, inhuman or degrading treatment or punishment.”