April 2, 2018 7:00AM # Multiple Distinguished Health Care Practitioners Speak Out Against Misguided Opioid Policy By [Jeffrey A. Singer](https://www.cato.org/people/jeffrey-singer) --- SHARE On March 30, Sally Satel, a psychiatrist specializing in substance abuse at Yale University School of Medicine, co-authored an article with addiction medicine specialist Stefan Kertesz of the University of Alabama Birmingham School of Medicine [condemning](https://slate.com/technology/2018/03/pill-limits-are-not-a-smart-way-to-fight-the-opioid-crisis.html) the plans of the Center for Medicare and Medicaid Services to [place limits](https://www.nytimes.com/2018/03/27/health/opioids-medicare-limits.html?smprod=nytcore-iphone&smid=nytcore-iphone-share&mtrref=t.co&gwh=0ABB3E788A8CE15B8FFD924E33FB6901&gwt=pay) on the amount of opioids Medicare patients can receive. The agency will decide in April if it will limit the number of opioids it will cover to 90 morphine milligram equivalents (MME) per day. Any opioids beyond that amount will not be paid for by Medicare. One year earlier, Dr. Kertesz made similar condemnations in a [column](http://thehill.com/blogs/pundits-blog/healthcare/326095-as-a-physician-i-urge-other-doctors-to-cut-back-on-prescribing) for The Hill. While 90 MME is considered a high dose, they point out that many patients with chronic severe pain have required such doses or higher for prolonged periods of time to control their pain. Promoting the rapid reduction of opioid doses in such people will return many to a life of anguish and desperation. CMS’s plan to limit opioid prescriptions mimics similar limitations put into effect in [more than half o](http://www.ncsl.org/research/health/prescribing-policies-states-confront-opioid-overdose-epidemic.aspx)f the states and is [not evidence-based](https://www.tandfonline.com/doi/full/10.1080/08897077.2017.1345194). These restrictions are rooted in the false narrative that the opioid overdose problem is mostly the result of doctors over-prescribing opioids to patients in pain, even though it is primarily the result of non-medical opioid users accessing drugs in the illicit market. Policymakers are implementing these restrictions based upon a [flawed interpretation](https://www.cato.org/blog/politicians-cannot-stop-punishing-patients-unintended-consequences-drug-prohibition) of opioid prescribing guidelines published by the Centers for Disease Control and Prevention in 2016. Drs. Satel and Kertesz point out that research has yet to show a distinct correlation between the overdose rate and the dosages on which patients are maintained, and that the data show a majority of overdoses involve multiple drugs. (2016 data from New York City show [97 percent involved multiple drugs](http://www1.nyc.gov/assets/doh/downloads/pdf/epi/databrief89.pdf), and 46 percent of the time one of them was cocaine.) Not only are the Medicare opioid reduction proposals without scientific foundation, but they run counter to the recommendations of CMS in its 2016 guidelines. As Dr. Kertesz [stated](http://thehill.com/blogs/pundits-blog/healthcare/326095-as-a-physician-i-urge-other-doctors-to-cut-back-on-prescribing) in 2017: > “In its [7th](https://www.cdc.gov/drugoverdose/pdf/guidelines_at-a-glance-a.pdf) recommendation, the CDC urged that care of patients already receiving opioids be based not on the number of milligrams, but on the balance of risks and benefits for that patient. That two major agencies have chosen to defy the CDC ignores lessons we should have learned from [prior episodes in American medicine](http://scholar.harvard.edu/nkc/publications/implications-recent-clinical-trials-pay-performance), where the appeal of management by easy numbers overwhelmed patient-centered considerations.” In an effort to dissuade the agency, Dr. Kertesz sent a [letter](https://docs.google.com/document/d/11Tp7kAkMc9S2wVGklaSwVub5ABeJGl76M5bX8N4LBRM/edit) to CMS in early March signed by 220 health professionals, including eight who had official roles in formulating the 2016 CDC guidelines. The letter called attention to the flaws in the proposal and to its great potential to cause unintentional harm. CMS will render its verdict as early as today. Until policymakers [cast off their misguided notions](https://www.cato.org/blog/stop-calling-it-opioid-crisis-its-heroin-fentanyl-crisis) about the forces behind the overdose crisis, patients will suffer needlessly and overdose rates will continue to climb. ##### Related Tags [Health Care](https://www.cato.org/health-care) [![Creative Commons License](/build/cato_2020/images/creative-commons.svg)](http://creativecommons.org/licenses/by-nc-sa/4.0/) This work is licensed under a [Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License](https://creativecommons.org/licenses/by-nc-sa/4.0/).