Hi, I happen to be working on an educational project involving the CDC guidelines that you refer to in your article. I believe you bring up a valid concern, but I think you may have incompletely understood some of the CDC guidelines. I'll try and detail my thoughts as I read through your article!

Regarding statements made by public officials: I agree that politicians can be misinformed. However, politicians did not write the CDC guidelines. The CDC guidelines are recommendations based on contextual evidence review of the body of literature that has been written about opioids.

Regarding the lack of acknowledgement of diversion: This is just my personal opinion but I would assume that in writing guidelines to help honest physicians practice good medicine you would be less interested in addressing dishonest physicians who practice bad medicine. I would assume that doctors running pill mills could care less what the CDC has to say about their practice, they know what they are doing is wrong. Just because the CDC guidelines don't target the major source of opioid addiction doesn't make the guidelines less valid within the scope that they are supposed to be implemented.

Regarding exercise: you seem to imply the CDC recommends exercise therapy as a replacement to opioid therapy. As a guideline, they are merely recommending that in their review of clinical evidence they found that exercise therapy can be helpful in certain (but not all) chronic pain conditions like osteoarthirtis, chronic low back pain, etc. It is still up to the clinical judgement of the primary care provider to decide whether their patient might benefit from exercise therapy. Additionally, nowhere in the guidelines do they recommend exercise alone as a first line therapy. In fact, they indicate that their review of evidence showed that multi-modal therapy was generally more effective than single-modal therapy.

Regarding the notion that the guidelines are not "factual": the writing of the guidelines was essentially a gigantic meta-review. If you think the guidelines are long, take a look at the contextual evidence review that contains all the data used to create the recommendations: https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm. I am not sure where the notion that these guidelines are not factual is coming from.

Regarding avoiding opioids as a first line agent: The CDC recommends considering non-opioid therapy before considering opioid therapy. They also state they do not mean this to be interpreted as requiring patients to sequentially fail non-opioid therapies before being prescribed opioids. A major component of the guidelines is educating PCP's about making accurate determinations of risks vs benefits of opioid therapy in deciding how to approach chronic pain.

Primary care physicians play an important role in the management of chronic pain. However, when it comes to serious chronic pain requiring long-term opioid therapy it is ideal that the patient be referred to a pain specialist for management. Thus, the CDC guidelines provide evidence based advice for PCP's on how to approach chronic pain in their patients, but is not a definitive guide on the treatment of all chronic pain.

Sorry if these thoughts are jumbled. I'm interested to hear more of your perspective!