It is like a dog chasing its tail.. when he stops still in the same place


Committees Support CDC Opioid Guidelines

By Pat Anson, Editor

Two advisory committees expressed broad support Thursday for the controversial guidelines for opioid prescribing being developed by the Centers for Disease Control and Prevention (CDC). Those guidelines discourage primary care physicians from prescribing opioids for chronic non-cancer pain and recommend other therapies such as over-the-counter pain relievers, acupuncture, and cognitive behavioral therapy.

One newly formed committee — which the CDC calls a “workgroup” — did express “significant concern” about the cost of those alternative pain therapies and whether they are covered by insurance. The workgroup’s report to the CDC’s Board of Scientific Counselors (BSC) also suggested that the guidelines be “framed with positive rather than negative language” that supports “integrated care for people with chronic pain.” It also recommends the impact of the guidelines be monitored for “unintended consequences” after they are implemented. 

The BSC voted to support the workgroup’s report, which can be found here.

“The BSC voted unanimously: to support the observations made by the BSC Opioid Guideline Workgroup; that CDC adopt the guideline recommendations that, according to the workgroup’s observations, had unanimous or majority support; and that CDC further consider the guideline recommendations for which the workgroup had mixed opinions,” said CDC spokesperson Courtney Leland in an email to Pain News Network.

“CDC is taking the BSC’s recommendations, as well as comments received from the public, into consideration in revising the guideline. The guideline is a priority for our agency. Given the lives lost and impacted every day, we have an acute sense of urgency to issue guidance quickly.”

The CDC planned to implement the guidelines this month with little public input, but was forced to change course after widespread criticism about its secrecy and lack of transparency during the drafting of the guidelines. In response to critics, the 10-member workgroup was formed three weeks ago and met four times by teleconference to review the guidelines. A potential legal problem for the CDC is that none of the workgroup’s meetings were open to the public. The workgroup also reviewed the guidelines with outside consultants without publicly disclosing who they were.

The Washington Legal Foundation (WLF) has threatened to sue the agency for its “culture of secrecy” and “blatant violations” of the Federal Advisory Committee Act (FACA), which requires meetings to be open to the public.

Over 4,300 online comments were received by CDC during a public comment period that ended earlier this month. Many opposed the guidelines as being too restrictive, while others wished the guidelines were stronger to combat the so-called epidemic of opioid abuse and overdoses.  There were passionate arguments on both sides, but in the end the workgroup decided that the case for the guidelines was stronger.

“Comments from patients and family members, in particular, expressed the desire that patient-centered care is enhanced rather reduced by these Guidelines. Members felt that the guidelines could be implemented in a manner consistent with patient centered care,” the workgroup said in its report.

As many as 11 million Americans use opioids for long-term chronic pain and many fear losing access to the drugs if the guidelines are adopted.

“The purpose of the guideline is to help to primary care providers offer safer, more effective care for patients with chronic pain and to help reduce opioid abuse disorder and overdose from these drugs,” said Debra Houry, MD, director of the CDC’s National Center for Injury Prevention and Control, which is overseeing development of the guidelines.

“The guideline itself is not a rule, regulation or law. It is not intended to deny access to opioid pain medication as an option in pain management. It is not intended to take away physician discretion and decision making.”

“Pain specialists and their patients fear the Guidelines will not be used that way though and adoption by boards, professional organizations, and insurers will pressure even specialty pain providers to taper patients,” said Anne Fuqua, a chronic pain sufferer and patient advocate. “Pain patients nationwide have been experiencing dose reductions and losing access to care altogether for several years, with the situation becoming more acute in the past year.  In an environment where physicians are tapering patient doses or ceasing opioid prescribing altogether, I feel these guidelines will serve like an accelerant in a growing fire.”

Although the CDC has said it doesn’t want the guidelines implemented until they are finalized, Fuqua said many doctors are already doing just that. She said her faith in democracy “took a swift kick in the teeth” as she listened to the workgroup’s presentation during a conference call. Fuqua was not given an opportunity to speak, although the president and founder of Physicians for Responsible Opioids Prescribing (PROP) were given time to address the BSC in support of the guidelines they helped draft.

“There were 28 comments supporting the Guidelines and 4 dissenters. One physician made statements partially supportive of our needs. CDC will no doubt use this ‘overwhelming support’ to justify adoption of the guidelines. I fear they see us as simply a casualty of war, much like those with tuberculosis who were quarantined to prevent disease spread. The only difference is that harming us doesn’t save other lives,” she said.

CDC has not released a timetable on when it plans to finalize or implement the guidelines.

4 Responses

  1. It’s a dog and phony show (no, that’s not a misspelling). The decision was already foreordained before all the public uproar was created by the announcement. The only purposes that the show had were to:
    1) Create an illusion of a democratic process.
    2) Let the powers that be see how much actual dissent there was, so that the timing and speed of the new policy roll out could be gauged, in order to manage the push back generated by it all.

  2. When the deck is continually stacked against you, it’s not a war on pain patients anymore, it’s one long constant assault committed while the authorities stand by and watch, hell, even cheer at the carnage.

    That comment session was a sham. Only a few token pro-opioid comments were allowed in, while every opiophobic person you could think of in your worst nightmares were ushered right in, offered a drink and an hors d’oeuvre, while they read their prepared diatribe, specialized rhetoric reserved for use in only the most insincere settings. Settings like these, a show worthy of an Oscar, if you were dumb enough to believe it was anything but a show.

    This show mixed a pretend caring for people detested by the speakers. The addicted, or as we in the pain community know them, the future patients of Kolodnyland, and chronic pain patients, the desired future patients of Kolodnyland. When the happy day arrives that no more opioids are available to anyone, Kolodnyland will be all that’s left? Not for me. I will jump of a building long before that happens!

    The show was sickening, disheartening and made me wonder why any of us made a comment. Clearly, nobody was the slightest bit interested in anything WE had to say. We obviously had plenty to say, too. What a damn shame.

  3. Acute pain constantly, amen, walk a mile in someone else shoes and they would drop all the harassment

  4. I think one of the main problems is that those who don’t suffer from chronic pain don’t understand that there is a fine line between acute and chronic pain — if that line exists at all. Can a chronic pain patient differentiate between acute and chronic pain? Because I know that some of my pain is low level, but some of it is also acute. And I think most people would agree that acute pain deserves treatment.

    There is no way that I will ever believe that the CDC took into consideration the thousands of comments made by pain patients. No, this was a foregone conclusion, and it will be the very last time that I try to influence a government agency. It’s just a waste of time, effort, and only results in more pain.

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