New guidelines released by the Centers for Disease Control and Prevention on opioid painkillers have drawn a mixed response from medical organizations. While acknowledging the epidemic of opioid abuse and overprescribing in recent years, some groups expressed concern that tight guidelines would limit physicians’ power to help patients with serious pain concerns.

The new CDC guidelines, released last week, state that opioids should be a last-resort treatment for chronic pain, after physical therapy, exercise, and over-the-counter medications. More powerful opioids carry a high risk of addiction and strain state healthcare infrastructures, so much so that the topic took center stage at the February meeting of the National Governors Association. According to CDC statistics, more than 28,000 people died in 2014 from opioids, which include prescription painkillers and heroin.

In issuing the nonbinding guidelines, “we’re trying to chart a safer and more effective course for dealing with chronic pain,” CDC director Dr. Tom Frieden told the Associated Press. “The risks of addiction and death are very well documented for these medications.”

The American Medical Association responded with a note of caution. “If these guidelines help reduce the deaths resulting from opioids, they will prove to be valuable,” said AMA board chair-elect Patrice A. Harris in a statement. “If they produce unintended consequences, we will need to mitigate them. They are not the final word.”

The American Academy of Pain Medicine echoed that point. In a statement, AAPM said it “cautiously supports” the guidelines. “Public health problems are typically complex,” said Dr. Dan Carr, AAPM president. “Well-meaning, but narrowly targeted, interventions often provoke unanticipated consequences.”

The American Academy of Pain Management challenged the CDC more forcefully, calling the dosage recommendations “arbitrary” and claiming that the guidelines took little note of public comments and input. “While CDC undoubtedly is well-intentioned, achieving this goal must be done in a way that does not harm the vast majority of people using opioids to manage their chronic pain—who have a positive risk/benefit ratio and who do not misuse or abuse their vital medications,” academy executive director Dr. Bob Twillman said in a statement.

Some state organizations had attempted to get ahead of the CDC on the opioid issue. In December, six Missouri healthcare organizations collectively issued their own guidelines to reduce the number of opioid prescriptions and to reduce patients’ “doctor shopping” to accumulate multiple prescriptions. And earlier this month, the National Association of Counties and National League of Cities announced a task force designed to find community-based solutions to the epidemic.

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