And Approves Opioid Guideline Workgroup in Public Conference Call
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
- Clinical Research
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.
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.