Kurt W.G. Matthies
What happened?
On November 17, 2015 the Washington Legal Foundation sent a formal letter to the Center of Disease Control (CDC) and its executive leadership, asking them to withdraw their Draft Guideline for Prescribing Opioids for Chronic Pain, and to make public the work of their Core Expert Group (CEG), a group central to the development of this document.
Who is the Washington Legal Foundation?
From their www.wlf.org /WLF Mission page:
“WLF is the nation’s premier public interest law and policy center. Our mission is to preserve and defend America’s free enterprise system by litigating, educating, and advocating for free market principles, a limited and accountable government, and individual and business liberties.”
What did this letter say?
The complaint states that CDC broke the rules laid down by the 1972 Federal Advisory Committee Act (FACA), which governs the behavior of federal advisory committees, and their work with the CEG should be discarded.
What is FACA?
FACA is part of a collection of legislative action by Congress that supports open-source governance. , to guarantee that their government be “objective and accessible to the public”.
FACA was developed during a time of challenges over the balance of power between the Executive and Legislative branches of the federal government. During the Johnson (1963-1968) and Nixon (1969-1974) administrations, executive power was being used to expand the Vietnam War, investigate political ‘enemies’, obfuscate public information about government activities considered ‘negative’ by a particular administration, and interfere with ongoing investigations of government wrong-doing.
This was the time of the Vietnam War, an active counter-cultural movement, and Watergate. It was a time when The People felt they had lost control of their government – and they wanted it back.
Other legislation from this period was designed to make government more accountable to the people, and to curb the excesses of the federal government included the 1966 Freedom of Information act and the 1976 Government in the Sunshine Act.
What is the CDC Draft Guideline for Prescribing Opioids for Chronic Pain?
Good question. No one outside of the CDC and their CEG knows, and that’s the problem in a nutshell.
The CDC is attempting to respond to a rise in opioid use, and a rise in what they call opioid-related deaths. If you’ve been paying attention, you know that the National Pain Report has been presenting a series of articles about this problem, and the ongoing controversies surrounding these two issues. The “guidelines” are an attempt to control what they consider to be “the opioid crisis.”
These issues and the controversies that surround them are complex, and have been discussed and will continue to be followed by this online journal, as well as other online sources of information interested in the treatment of pain in America, and will not be repeated here.
Why is the CDC being criticized?
It’s called mushrooming. The experts advising the CDC on opioid policy, their “Core Expert Group,” are being kept secret from the public. That’s against the law.
Remember, mushrooms grow in the dark – which is where the CDC Guidelines are being developed.
The Washington Legal Group, and many interested in the treatment of pain in America want to know what their government is planning, and want greater input into the creation of these Guidelines, if they want them at all.
What will happen next?
Last year, Americans with an interest in the treatment of pain were promised an open, scientific dialog on the problems and possible solutions of a problem that involves 100 million Americans in pain, and over $600 billion dollars in annual medical expenditures in what was called a National Initiative on Pain. That effort failed many stakeholders, miserably.
Now, we’re getting a three ring circus of claims that include decrees of epidemics in Heroin use, addiction, and death. These negative outcomes have been laid at the door of “the out-of-control pain community” for its excessive pain prescribing practices.
The CDC is a respected institution, but has been known to make some bad decisions in the history of the American Public Health. Now they are planning guidelines, which really act as laws that many believe will call for the reduction of opioids in the treatment of pain — and they’re doing it in secret committees, behind closed doors, planning to release a final guideline document in January: signed, sealed, and delivered by fiat. This document will affect the quality of lives of millions of Americans who depend on opioid analgesics to function near the limits of normality, due to chronic pain disorders.
In America, we frown on governments that break the rules. We frown on government by fiat. We are a nation of people who believe in public discourse on important issues, which is guaranteed in our constitutional freedoms. When threatened, we have proven again and again, that we will fight for those freedoms.
The CDC has chosen to mushroom their consulting expert group because many come from the perspective that opioids have no proper use in the treatment of chronic pain.
In my November 9 opinion piece for NPR, The Power of Numbers/ Stand Up and Be Counted, I speculated on a few reasons why the CDC might want to keep their work a secret:
Perhaps now we’ll find reasons why they chosen to keep their work out of the light.
The Side Show
There’s talk that CEG member Jane Ballantyne, MD, FRCA, president of Physicians for the Responsible Opioid Prescribing (PROP) is the author of these guidelines. She also consults to a large Washington law firm that has been involved in litigation against the major opioid manufactures. The WLG information is asking the question:
Is there a conflict of interest here?
Soon after this letter went public last night, Dr. Andrew Kolodny, MD, Executive Director of PROP, and Chief Medical Officer of Phoenix House, a large addiction treatment organization, announced last night — there is no conflict of interest.
Look for breaking information on this important issue in these pages.