Those who follow my work on Linked In, in social media and in medical journals will be aware that I am a sharp critic of the U.S. Centers for Disease Control and Prevention (CDC) and its 2016 Guideline for Prescribing Opioids for Chronic Pain to adults with chronic non-cancer pain. You will also be aware that I follow current events very closely in this area of public policy. Thus, I was notified of the pending July 22 meeting of the Board of Scientific Counselors of the US CDC National Center for Injury Prevention and Control (NCIPC) . This meeting will discuss an ongoing effort to update and expand the CDC guidelines, to be monitored by an Opioid Workgroup whose members have so far not been identified to the public.

I have registered to speak at the NCIPC meeting. And I encourage others to register for one of the 2,000 listen-only webinar gateway slots provided by CDC. Those wishing to do so may visit https://www.surveymonkey.com/r/NVV9XM2/.

For those who wish to, I would suggest an additional resource with potentially far reaching and revolutionary impact. The American Medical Association (AMA) has registered a 17-page commentary of recommended updates and changes to the CDC guidelines, in the recent Federal Register call for stakeholder comments on management of acute and chronic pain. Among other points made by the AMA are these:

• AMA accuses the CDC of unnecessary harms to patients and physicians, with 2016 guidelines that were not only “misapplied” but wrong on science and not monitored for destructive outcomes.
• AMA proposes that the CDC work actively for the retraction and elimination of all State and Federal limits on opioid dose levels or duration.
• AMA reinforces the message of the 2018-2019 DHHS Task Force on Pain Management that there is no one-size-fits-all patient or treatment plan, and patient care must be individualized by the attending physician.
• They urge the CDC to make clear that any revised guideline is not to serve as a law enforcement or State Medical Board standard in prosecutions or sanctions against physicians.

If you cannot access the AMA comments online, then feel free to email me at lawhern@hotmail.com, and I will send them to you.

The public comments segment of the NCIPC agenda is 40 minutes long. If you intend to speak, then I strongly recommend that you prepare your remarks in advance, rehearse your delivery, and plan on speaking  no more than three minutes — that is approximately 360 words spoken at a moderate pace. If you would like to rehearse your delivery by phone in advance, then feel free to let me know, and we can set up a call.

The following are the remarks I intend to offer, if the meeting organizers do not  conveniently bar my voice from their proceedings:

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Three Minutes to Change the World

Richard A. Lawhern, PhD
Presentation to the Board of Scientific Counselors
Of the CDC National Center for Injury Prevention and Control

July 22, 2020

Good day.  I am Richard A. Lawhern, PhD, a co-founder of the Alliance for the Treatment of Intractable Pain. I am a non-physician patient advocate with 24 years experience in this field and over 90 published articles and papers. I speak on behalf of millions of pain patients who have been profoundly and needlessly damaged by the 2016 CDC Guidelines on prescription of opioids. I have no financial conflicts of interest.

As this body deliberates on the revision of the CDC guidelines, you must embrace these facts:

• The US Agency for  Healthcare Research and Quality  informs us that there are no profiling instruments that accurately predict risks of opioid dependency, tolerance, or addiction in individuals. However, as they fail to inform us, there never will be.
• Genetic polymorphism in P-450 series liver enzymes that metabolize opioids generates a wide natural range of minimum effective dose. Case reports indicate some patients are helped by as little as 20 MMEDD, while others benefit from over 2000 MMEDD — without significant side effects,sometimes  for periods of years.
• Over-prescribing did not create our US opioid “crisis.” Dr Nora Volkow, Director of NIDA, tells us “addiction is not a predictable outcome of opioid prescribing.”  Risk of addiction to medically managed opioids is less than 1%. Overdose mortality is three to six times higher in youth under age 24 than in seniors over age 62. But prescribing in seniors is three to six times higher than in youth. U.S. states with higher prescribing rates have overdose mortality rates below the national average.
• The American Medical Association has repudiated MMED as a measure of risk or benefit, and characterized “high prescriber” letters as a blacklisting of doctors and their patients, violating legal due process. Denial of pain care when it is available constitutes patient abuse and desertion.

It is time to admit publicly that the 2016 CDC guidelines were not only misapplied, but wrong on facts, science, and medical ethics. Contrary to the narratives of fringe element anti-opioid zealots and their insurance company sponsors, medically managed opioid analgesics are safe, effective and indispensable. For millions of pain patients, no effective alternative treatments exist.

Thank you for letting me speak.

Richard A. Lawhern, PhD is a technically trained non-physician advocate and online forum moderator with over 22 years experience, communicating with tens of thousands of patients and caregivers.  He has published over 90 papers and articles in both popular media and professional medical journals.   He supports the editorial board of the journal Practical Pain Management.