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The health-care providers, including three former U.S. drug czars, said the CDC recommendation of a daily numerical threshold for opioid use has led insurers to refuse reimbursement, pharmacies to erect obstacles to obtaining drugs and risks for doctors who want to give out more.

The role of opioids for chronic pain has been one of the most contested aspects of the nationwide crackdown on narcotic prescribing. The CDC guidelines, issued in 2016, assert there is little evidence for the use of opioids against pain beyond 12 weeks.

But many patients have claimed that long-term use of the drugs is all that stands between them and unrelenting pain, and that they can take the medication without becoming dependent or addicted. The accumulation of that anecdotal evidence led to the experts, who call themselves Health Professionals for Patients in Pain, to write to the CDC.

The National Institutes of Health is studying the issue as part of its Helping to End Addiction Long-term Initiative and last week the Food and Drug Administration ordered drug companies to examine whether opioids are effective against chronic pain.In the meantime, the number of opioid prescriptions issued annually has fallen sharply, from a peak of more than 255 million in 2012 to 191 million in 2017, according to the CDC. Many states have enacted limits on opioid prescribing.

Still, 47,600 people died of opioid overdoses in 2017, more than 17,000 of them from legal painkillers such as oxycodone, hydrocodone and methadone.The CDC guidelines suggest 90 milligrams of morphine or their equivalent as a daily ceiling for opioid use against pain. But the letter said insurers, regulators and others have used the figure as both a professional standard and a threshold for professional suspicion.The group called on the CDC to investigate the damage that the limit may be doing to patients and to clarify the guidelines, especially in regard to discontinuing patients’ opioid use.