ASAM Welcomes CDC Letter Clarifying Dosage Thresholds

Several weeks ago, the American Society of Addiction Medicine (ASAM) contacted the Centers for Disease Control and Prevention (CDC) to discuss the persistence of misunderstandings surrounding dosage thresholds in the CDC Guidelines for Prescribing Opioids for Chronic Pain – 2016 (Guideline) and addiction medicine. The CDC promptly responded to this concern with a letter confirming that dosage thresholds in the Guideline were not meant to and should not apply to dosing of opioid agonists/partial agonists used for the treatment of opioid use disorder.

The letter describes steps the CDC has taken to clarify this issue and highlights ASAM’s work to clarify this issue through ASAM’s Public Policy Statement on Morphine Equivalent Units/Morphine Milligram Equivalents and other communications.

“ASAM greatly appreciates CDC’s cooperation with the issuance of this letter of clarification. The treatment of addiction differs from treating chronic pain, and the risks, benefits, and safe medication dosages of longitudinal treatment with opioids differ as well. Both methadone and buprenorphine have been demonstrated to decrease overdose risk when used to treat addiction involving opioids, and increasing access to these medications for patients with opioid addiction should be a key strategy to reduce overdose deaths,” said Dr. Kelly J. Clark, president of ASAM.

 EDIT: May 4, 2018

The AMA and ASAM have worked with Appriss Health, the developer of more than 40 state PDMP platforms, to ensure that buprenorphine for the treatment of opioid use disorder has been removed from all displayed MME calculations throughout its system. Appriss Health reported that it deployed a full system update on April 11, 2018 that clearly separates buprenorphine from opioids that are used for the treatment of chronic pain and strengthened guidance to exclude medications used for MAT from CDC recommended MME limits (i.e. 90 MME). Below is an example screenshot provided by Appriss Health which illustrates this change.