Oversight on Revision of US CDC Opioid Guidelines: A Process Pre- Destined to Fail

In December 2019, the US Centers for Disease Control and Prevention (CDC) announced their intention to review and revise their 2016 Guideline on Prescription of Opioids to Adults. As part of this revision, CDC solicited nominations for an advisory “Opioid Workgroup” to report to the Board of Scientific Counselors of the National Center for Injury Prevention and Control. This paper offers a critical review of concerns identified in the final Workgroup report of July 2021, as contrasted against the revised and expanded guidelines published 16 months later in November 2022. The author finds that although the Workgroup was tasked to identify substantive issues, its input to the CDC was largely marginalized or ignored in the revised guidelines. The workgroup also failed to reach consensus on central issues of methodology, which should disqualify the CDC guidelines as a de factor standard of clinical practice. Arguably, the CDC should be removed from all further participation in development of public policy for the treatment of severe pain.