CHARLESTON — West Virginia Attorney General Patrick Morrisey and other AGs are expressing concern that a draft pain management directive could weaken restrictions on the prescribing of opioid painkillers, something Morrisey has pushed for in West Virginia.
The bipartisan coalition of 39 state AGs worries a draft pain management report currently under consideration by the U.S. Department of Health and Human Services deviates from guidelines aimed at decreasing the risk of opioid misuse as set forth by the Centers for Disease Control and Prevention.
“Moving away from the CDC Guideline at this critical time would undermine ongoing legislative initiatives, as well as refinements to standards of medical care,” the National Association of Attorneys General letter dated March 31 states. “As a matter of public safety, there is simply no justification to move away from the CDC Guideline to encourage more liberal use of an ineffective treatment that causes nearly 50,000 deaths annually.”
The group of AGs expressed its concern in a letter to Dr. Vanila Singh, chief medical officer for the Office of the Assistant Secretary for Health at the U.S. Department of Health and Human Services.
Morrisey says the HHS draft pain management report suggests providers can rely solely on their judgment instead of consulting the CDC’s evidence-based recommendations.
In addition to their risk for addiction, the bipartisan NAAG letter says opioids can often be ineffective in managing pain. The letter includes several other concerns, including that HHS neither provides a reason for departing from evidence-based CDC guidelines, nor explicitly states that there is no completely safe opioid dosage.
"For many years, state attorneys general have been fighting the opioid crisis on numerous fronts, from protecting consumers against deceptive marketing of prescription opioids to closing pill mills," the letter states. "While this crisis continues, it is incomprehensible that officials would consider moving away from key components of the CDC Guideline for Prescribing Opioids for Chronic Pain ...
"The well-established risks associated with higher doses of opioids, prescriptions of longer duration, and concurrent prescriptions of opioids and benzodiazepines demand reasonable guidelines to inform appropriate decision-making.
"The Draft Report should be revised to clearly state that there is no completely safe opioid dose, and that higher doses are particularly – and predictably – risky."
The letter says that since the CDC guideline was issued, the evidence has continued to mount that opioids achieve limited pain relief for chronic noncancer pain and are often no better than other options for treating acute pain.
"As attorneys general we have witnessed the devastating effect of unfettered opioid manufacturing, distribution and prescribing on our public health, social services and criminal justice systems," the letter states. "The well-established risks associated with higher doses of opioids, prescriptions of longer duration, and concurrent prescriptions of opioids and benzodiazepines demand continued constraints.
"As a matter of public safety, there is simply no justification to move away from the CDC Guideline to encourage more liberal use of an ineffective treatment that causes nearly 50,000 deaths annually."
In West Virginia, Morrisey's office has developed a best practices toolkit for opioid prescribing and dispensing endorsed by more than 25 national and state stakeholders, and led a first-of-its-kind effort to empower doctors and pharmacists with the right to refuse opioid-based medication without fear of retaliation.
The AGs from Montana and Washington state led the NAAG letter, which also was signed by the AGs from Alaska, Colorado, Connecticut, Delaware, District of Columbia, Florida, Guam, Idaho, Illinois, Iowa, Kentucky, Maine, Maryland, Massachusetts, Minnesota, Mississippi, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Puerto Rico, Rhode Island, South Carolina, South Dakota, Utah, Vermont, Virginia and Wyoming.