US Opioid Guidelines 2022 – More and Less Than Meets The Eye

Abstract

The United States is currently embroiled in a contentious and multi-dimensional public conversation about addiction-related mortality, chronic pain, and government regulation of clinicians who employ opioid analgesic pain relievers in treating pain. The US Centers for Disease Control and Prevention (CDC) have published and updated guidelines to clinicians concerning appropriate practices for managing severe chronic pain by means of opioid analgesic pain relievers. This Critical Policy Review briefly outlines the history of US public health policy on regulation of prescription opioid pain relievers. The author then compares recommendations and data sources of the updated November 2022 CDC guidelines against findings from a wide range of pertinent clinical literature. He finds that the most recent effort by CDC is fatally flawed by weak evidence and methodologically unsound research, disproportionate emphasis on risk, and failure to address genetically mediated variability in minimum effective opioid dose between individuals. Compounding these difficulties are indications of professional conflicts of interest and persistent anti-opioid bias on the part authors of the most recently released CDC guidelines.