Feds Stay On Message Re: CDC’s Guideline for Prescribing Opioids

Feds Stay On Message Re: CDC’s Guideline for Prescribing Opioids

And Approves Opioid Guideline Workgroup in Public Conference Call

By: Staff

In a public conference call today, the Centers for Disease Control and Prevention (CDC), did three things: 1) reinforced CDC’s talking points outlined in its highly controversial CDC Guideline for Prescribing Opioids for Chronic Pain, 2) stated the data behind the Guidelines are robust, and 3) it used a transparent process nominating a Workgroup of experts to advise its Board of Scientific Counselors (BSC).

The conference call number provided in the Federal Register was changed the morning of the call, requiring individuals interested in participating to obtain the new phone number and passcode.

CDC spent the first portion of the public call outlining the high-level data points from its website, including that 259 million opioid prescriptions were written in 2012, which is an increase of 300% since 1999, and that the Guidelines are about addiction and overdose.

CDC described how robust the data are behind the Guidelines, leading one BSC member to comment on the “huge effort” and “amount of work” that went into the data analyses. CDC outlined that the data are “balanced” and include “clinical and contextual evidence” requiring some “art to interpretation.”

Discussion shifted toward implementation of Guidelines, with NIH stating its interest is in future studies to see if the Guidelines will change clinical practice.

The conference call was stopped because the meeting was ahead of schedule and participants were asked to reconvene 30 minutes later to discuss the Opioid Guideline Workgroup and to hear comments from the public.

Opioid Guideline Workgroup

The BSC approved the CDC’s nominees for the Opioid Guideline Workgroup, which will review the draft Guidelines and public comments, and ultimately provide CDC with recommendations for final Guidelines.

CDC described its “transparency” and “balance” with respect to its selection of the new Workgroup that represents more pain management expertise than its previous Core Expert Group.  One participant commented, “I am impressed by the amount of feedback sought by a variety of experts in the field.”

CDC was under fire for its secretive formation of the Core Expert Group, which grabbed the attention of the U.S. House Committee on Oversight and Government Reform, which wrote to CDC about “not provided clear information regarding the ‘Core Expert Group’s’ role.”

The Workgroup composition is intended to provide balance to the issues and represent the primary disciplines and parties most affected by opioid prescribing.  The suggested composition includes specialists in the following fields:

  • Primary Care Physicians
  • Emergency Medicine
  • Public Health
  • Pain Patients
  • Substance Abuse Treatment
  • Pharmacies
  • Clinical Research

Public Comments

The public was given approximately one hour to comment on the Opioid Guideline Workgroup, limiting each speaker to two minutes.  Additionally, CDC said they “will be accepting public comments only related to the formation of the Opioid Guideline Workgroup” (not the guidelines themselves).

Many people with chronic pain shared their personal experiences and opinions on the Guidelines, describing their needs for opioids to manage pain. Moderators reiterated that comments should be focused on the Workgroup, and not on the Guidelines.

Several pain sufferers and clinicians suggested that the Workgroup include a pain sufferer, or a clinician with experience treating individuals who require high doses of opioids.

CDC noted that the current Workgroup does include a pain patient advocate, and asked if another patient advocate is needed.  One BSC participant said, “Having a second or more makes sense” and that perhaps having 30% of the Workgroup representing advocates makes sense.

Several family members who have lost loved ones to overdose shared comments, adding that the Workgroup should also have representation of a parent who has lost a child to overdose.

CDC said the work should be completed as soon as possible “given the urgency of the matter.”

The Workgroup will meet four times, although CDC did not give a timeline.  The date and time of the next conference call will be published in the Federal Register.

The public has until January 13, 2016, to submit comments on the Guidelines themselves.  To comment visit this website.  To read the 56 page Guidelines and report, visit this website.

CDC says that among the 1,900 comments to date, they are getting “fantastic feedback” from groups representing different views on the Guidelines and believe they will find experts from these comments to help the Workgroup as consultants.

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Authored by: Staff

There are 19 comments for this article
  1. Mr Clusters at 7:21 pm

    Instead of those idiots in Oregon occupying a federal building there, the main CDC building was occupied and PATIENTS demanded pain relief, I BET 10,000 people or more would’ve showed up to support them. These new “Guidelines” are going to KILL MORE PEOPLE and hurt alot of others. Many will feel forced to switch to other opiods that are available, such as heroin, or they’ll possibly even feel forced to commit suicide just to relieve their pain. I hope they’ll keep the stats on this as well as the few that abused, sell, and/or overdose on their own prescription medications.

    Something needs to change and it needs to start with this “Guideline” ASAP!! DON’T KILL US OFF BY MAKING US SUFFER. SUFFERING PEOPLE WILL END UP FIGHTING.

  2. Jane at 3:39 am

    If anyone reading this is going to comment during the call (I didn’t sign up in time), ask them how the CDC is planning to track the efficacy of their Guideline, particularly any increase in pain patients resorting to use of illegal drugs and/or suicide, and what they plan to do if the number of opioid relates deaths increases as a result of the Guideline’s implementation.

    Ask if they considered the estimated 16,500 annual deaths from NSAIDs when they recommended them over opioids, which only result in 16,000 deaths, or is it acceptable if more patients die from their meds as long as they don’t die from opioid oversose.

  3. J. P. at 7:03 pm

    My mother in law suffers daily due to chronic pain. The pain meds allow her to get out of bed each morning. If you take these meds away, you are taking away her quality of life.

  4. Holly K at 7:56 am

    There’s a ‘prescription epidemic’ but it isn’t opiates. Opiates have become very inexpensive and I believe that’s partially what’s fueling the anti-opioid agenda and the propaganda; Greed.

    Doctors are pushing prescriptions for gabapentin, pregabalin, and anti-depressants that leave patients in a perpetual ‘fog’ making them much easier to control, and therefore herd into the lucrative “injection mills” and other lucrative procedures. If that doesn’t work, try and convince everyone that the lucid pain patient, who still insists that an inexpensive opioid is very effective at relieving their pain, is suffering from the sinister-sounding “opioid dependence disorder”. Dependence upon life-saving insulin is acceptable, as is a dependence upon air, clothing, housing, or food. But dependence upon an opioid to function is a “disorder” and there’s an entire industry created (more greed) now ready to assist.

    In my personal experience, a doctor gave me more steroid injections in a month than I should have had in 6 months. This was 10 years ago, and he liked the $400 payment for a 10 minute visit. I, however, developed a severe reaction and he went from a huge smile when he saw me in his office, to stating “I hate you” when I said “No more injections, they’re going to kill me!”.

    Another doctor directed me to place 4 lidocaine patches on at once. I erred on the side of caution, as I do with all my prescriptions, and only used one. I had immediate loss of blood pressure, nausea, dizziness, and weakness. Had I stuck all 4 on, I’d probably be dead.

    Just recently, a doctor said he “doesn’t believe in pills” as he wrote, ironically, a prescription for a pill, (just not THAT pill, the one that has effectively, and inexpensively, both to myself and Medicare, relieved my pain) and set me up for 4 injections in my head; all at one time! A family member said “you KNOW you can’t have those injections”. and I said “I know, but if I refuse them, the doctors assume I’m ‘drug seeking’ and write ‘refused treatment’ in my chart”. He also insisted that I take gabapentin 3 times a day. I said that they are extremely dangerous; therefore I only take one occasionally before bed, as they cause very severe short-term memory loss. I forgot something on the stove several times, almost causing a fire, and I ‘forgot’ about my special-needs grandson, while watching him, several times while on them!

    The above are examples of the “conversation” many patients are having with their doctors. Any resistance to the doctors demands results in derogatory comments written in the patients chart, and the perpetual denial of anything affordable and effective (pain medicine) for pain relief. Now pain patients are being called “angry and difficult” for knowing what works for them as an individual! The derogatory comments about pain patients is incessant.

    Now there’s a focus on alzheimers, yet the real culprit is probably the exhorbitant number of prescriptions written to patients, especially the elderly. How many of you see it in your own families? How many of you see the perpetual ‘fog’ of family and friends from the combination of gabapentin, pregabalin and anti-depressants?

    Yes, let’s portray patients in pain as anything but cognizant of the real agenda and epidemic: Greed!

  5. Kerry at 7:47 am

    Dave, you are spot on! I said to the cdc and am saying to anyone that will hear that our fight should not be simply about opioids but rather better treatment and ultimately a cure! This should be the central message we need to be on!

  6. Dave at 6:52 am

    Despite over 40 years of poor pain care in the U.S., only recently has the sleep of people in pain been troubled. And, I dont think most people in pain are troubled over poor pain care.
    In addition, pain care advocacy organizations, have failed to come up with any viable plan that calls for dramatic change in pain care.
    Poor pain care didn’t happen over night-and it wasnt just do to a careless government or health care industry- it also came from people in pain who carlessly allowed pain care to come to the sorry state it is in now.
    While some people in pain are doing a remarkable job of trying to improve pain care- most are not- they are more or less overconformed to the status quo. Those who have taken pain care or pain care politics for granted can reform themselves and work toward a much different or better future for people in pain.
    There can be no doubt that poor pain care comes from all of us- the buck stops everywhere-and until people in pai take more resposibility for the system we have, i dot thik thigs will improve i pain care aytime soon. Pointing a finger at government or providers- thats easy-and lazy. Instead of cursing the darkness people in pain should light a candle to improve pain care.

  7. Kerry at 5:34 am

    Kathy, her name was Sherry Hamby and she brought up the fact of making the working group of up to 30% pain patients. You can google her name and find her I think.

  8. Kathy Hastings at 9:59 pm

    I am normally the optimistic person…..after the first hour of the conference, I tried to hold on to my optimism; it quickly went down hill. First of all, the entire first portion of the conference was nothing but everyone praising one another for their hard work, time and being a part of the call. Honestly, the praise was way over the top and in no way came off as sincere statements; other than, “You have my back and I have yours!” I honestly thought they were hoping after the exchange of praising and then to a break (which was completely unnecessary; seems to me if one is ahead of schedule, it would have allowed for more calls from the public listeners; or was I the only one to catch that?), I think the whole intent was to get many listeners to not return after the 30 mn break. It was very clear through the conference exactly what the goal was and it would be achieved regardless of SBC comments or public. Remember when a member of the SBC brought up possibility of tabling motion of acceptance of work group, so the SBC could review the comments and possibility of adding members, especially two names that were continuously submitted to the discussion by callers? All of a sudden, the language of the amendment changed and it was explained the two subjects were not considered as Work Group Members due to Conflict of Interest, the importance of the Work Group to get started immediately, blah, blah, blah….all of this was pushed by the CDC and I have to say from my listening of the conversation there was a member of the SBC of the last name Timmons, whom, I personally thought, had traded something for pushing everything through on the SBC side of the discussion. I wish I could remember the name of the lady, who first suggested tabling the approval of the work group; I do know she was the same person, who went on record as a voted “Nay” of the Motion to Accept. Although, some of the callers, through their comments, indicated how “out of touch” of the truth of what is going on currently, with regard to access to pain medications for chronic pain patients; the entire conference basically said, “These are the guidelines, they will be passed. We are only doing this in this manner to cya from the Courts.” I am saddened, angered, frustrated by the entire show of “monkey business” and yes, I do hope each and every person experiences pain w/o the aid of any pain medication! Please, let the power makers suffer the consequences of their own “lined pockets” as do the others, they care not about in this life. I could have wished worse…which to me would be for them to have to sit by and watch someone they love suffer the consequences of their guidelines, but, that is not fair to the loved one. Yes, it sounds mean and is completely out of my character; yet, I know of no other way for things to be changed in a different direction.

  9. Shannon G. at 2:01 pm

    I am appalled at being lumped in with addicted or drug abuse people just because I for some reason was struck with what seems to be a barrage of autoimmune diseases out of nowhere. I was a very healthy 36 year old when the first wave hit debilitating me to becoming bedridden. After having my 5th spinal surgery last month, and now being diagnosed with not 1, not 2, but 5 autoimmune diseases to date I am on a pretty high dose of pain meds just to be able to function and because of that I am able to no longer be stuck in a bed, but yet someone or several someone’s that have not suffered chronic agonizing pain every single day 24/7, wants to take that little ability away from me just because of some impartial studies??? I don’t think you CDC folks GET IT!!! I am not curable because all of my autoimmune diseases are without cures so focus on that please. I did nothing to contract or deserve to be struck down by lupus, fibromyalgia, Raynauds, sjrogrens, and AS but I am here now asking you all to be mindful that we that suffer and need these medications to be productive citizens, parents, spouses, children, and siblings need to be characterized differently. We didn’t ask to be this way, but we need to be considered just as important in your research as you pain specialist, your primary care physicians your other so called experts….because we are the ones on the front lines giving support emotionally, physically when we can, financially when we can to those in the same situation as us. I run three support groups online for this very thing. PLEASE LISTEN TO US!!!

  10. Rachel Pinsky at 9:13 am

    First off you should not put people with chronic pain in the same category as a heroin addict (drug addict).
    As a care-taker for someone who lives with chronic pain please do not take away their pain medications. By doing this you are taking away their lives.

  11. Rhonda at 1:02 am

    I wanna bet not a single one of the people working on changing the med laws have suffered or watched someone suffer with pain on a daily basis. These meds hàve given me back some portion of a normal life. I think you people need to study people that actually benefit from the use of opiates for pain patients and others. Before I began this regiment it took me almost an hr to get out of bed in mornings and that is if by chance I was even able to sleep at night because the pain and discomfort was unbearable.I am able to get get dressed without taking 2 hrs . I’m able to have some type of normal in my life and enjoy my family again because of these meds. It’s humiliating to be judged and labeled as an addict by doctors, nurses, pharmacists and people who have no Idea what I or any others have been through or going through.

  12. Albert Elrod at 8:02 pm

    I don’t understand how someone who has never experienced the life of a person with debilitating lifetime of chronic pain can know how HOPELESS and helpless we feel. I suffer everyday. It takes me an hour of wiggling around before I can even get out of bed in the morning. I’m praying one day that someone will give us the medicine we need to truly control our PAIN

  13. David Read at 7:01 pm

    As a pain patient who has always followed the “contract” to a tee and who has gotten his life back since being put on this medication, I feel thale population segment that has benefited from these medications needs to be heard and considered in these guidelines and not lumped into a group who have abused said medications. All I ask is that consideration is givin’ to those who have no desire or need to abuse something that has made the daily pain more tolerable and life easier under difficult health conditions.

  14. Rk at 5:39 pm

    Omg how ridiculous what the F DOES. a parent of an addict have to do w CHRONIC PAIN PATIENTS SUFFERING??THIS country is shot out N if i could afford to move out of it i would,

  15. Lynne Wilburn at 5:21 pm

    I was able to call in today on the CDC call and make a brief comment. I focused on the proposed 100mg equivalency of medicine which is being used as a “guideline”. I am under five feet and take over double this amount and I worry about having to lose quality of life due to what is being proposed. I also stated that if insurances would pay more for ketamine, many of us could replace opiates with ketamine infusions.

  16. Kerry at 4:34 pm

    I listened to all of the event with the exception of the first 15 minutes after being redirected to the new contact number. I was struck with a dichotomy of two entire worlds: one of folks who were able to make guidelines and one of folks who were trying to find a way to survive. The remarks from some of us who were suffering were just absolutely heart-wrenching and I am hopeful the CDC will hear us. There are no guarantees I realize but it did seem that their positions had softened some after our comments were heard to the place where they at least deliberated attempting to make space for another pain patient in their work group. They were certainly impressed with the over 1900 comments they had received regarding the proposals in the pain guideline draft. I do believe that the bigger picture is far worth more pursuing than simply one aspect of treatment and that is we need a cure! We need to stop being a cash cow for the next pain pill or pain managing gadget.

  17. Dave at 4:00 pm

    People in pain- and pain care advocacy groups- the CDC -and mainstream medicine are handing you a loss.
    Pain care advocacy groups and people in pain might be better served by approaching civil rights organizations and public interest law groups to improve the laws and rights of people in pain. For pain specialists and their organizations to believe their voice or their experience or their research would be enough for the CDC to “obey”- they were mistaken. My guess is the CDC and mainstream medical groups that are working with them see them as fringe organizations that have been sloppy with opioid use. By getting lawyers and professional advocates that focus on justice and rights- then you might change the game. Eve in NYS- not the most progressive state- Assemblyman Gottfried has repeatedly had bill to try to ensure the right to have access to medications for pain. Are your pain care advocacy groups willing and able to speak out about rights like MLK- frankly, i dont think so. But i think they need civil rights advocates on their Boards and working with them to create the symbols of a new day for people in pain. As MLK said- Of all the forms of unfairness- injustice in healthcare is the most shocking and inhumane”- when is the last time a pain care advocacy organization spoke so boldly about pain care issues in America?
    Until there are new energetic laws that focus on the right to humane and fair treatment for pain- guidelines, pious asseverations, pain strategies, etc- are all unenforceable when push comes to shove. Its time for rights based pain care- failing that the humane treatment of people in pain will continue to be uncertain, at best- and the dried voices of people in pain will remain mute and meaningless and as distant as fading stars.

  18. Bobbie Hudson Penick at 2:49 pm

    US Population
    279 million (1999)
    314.1 million (2012)
    I would wager this statistic has not been factored into this figure ” 259 million opioid prescriptions were written in 2012, which is an increase of 300% since 1999, and that the Guidelines are about addiction and overdose.”
    I would also wager not factoring in the fact ” America has been at war nonstop for the past 13 years.” which has added many injured soldiers with chronic pain conditions.
    Poor quality of food production, soil depletion, massive use of poisonous insecticides along with diets crammed with food filled with chemicals have contributed to a huge health crisis worldwide leading to many chronic pain conditions.
    Taking these factors and others I have not touched upon, is it not reasonable to see an increase in opioid use?

  19. Carla Cheshire at 2:44 pm

    THE GUIDELINES
    Did anyone bring up the fact that there didn’t seem to be any studies cited of long-term opioid therapy patients? Longer than a year?

    THE WORKGROUP
    The Workgroup contains ONE pain patient advocate and maybe they are considering another. How can they leave out pain patients, the people the guidelines will effect?
    How many people total are in the Workgroup?

    Additionally, CDC said they “will be accepting public comments only related to the formation of the Opioid Guideline Workgroup.”
    Where do we write to give input on the formation of the Workgroup?