It is Time for CDC to "Get Out Of Dodge" Concerning Public Policy for Pain Care

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A record of bias and incompetence disqualifies the The Centers for Disease Control (CDC) from further roles in creating public policy for treating patients in pain.

A recent article by Elizabeth G Dost in Newsweek Magazine is highly informative of the horrors -- and errors -- of prevailing public health policy concerning the management of severe chronic pain by means of clinically supervised prescription opioid pain killers. She writes:

​“I’ve been a nurse for 30 years.  Opioids saved my patients’ lives....As a registered nurse, I have been very familiar with opioids for years. Opioids are lifesaving and life-restoring medications. In acute care, they are essential for health, wellness, and recovery—both in short-term and long-term use....I have witnessed patients in excruciating pain find relief by taking opioids, allowing them to eat, sit up, walk, and engage in physical therapy. Throughout my career, I have consistently seen the beneficial use of opioid therapy...."

Dost has much further to offer that is worth reading.

Newsweek is only among the more recent mainstream media publications to confirm that CDC opioid prescribing guidelines have done enormous damage to millions of US pain patients and their clinicians. Other publications include Scientific American, the New York Times, and Washington Post.  These harms have even been acknowledged by the CDC itself.

But the story doesn't end there. It is now recognized widely that the 2022 "updated" CDC opioid prescribing guidelines – despite giving lip service to individualized patient care -- simply continue the sorry record of 2016. We see persistent use of junk science in Morphine Milligram Equivalent Dose thresholds employed to promote one-size-fits-all thinking about treatment.  Research has been conflated and cherry-picked.  Sweeping conclusions have been drawn from weak data – or no data at all. Anti-opioid bias and outright fraud reign supreme.

We now know that there is no relationship between doctors prescribing to their patients versus either hospitalizations for opioid toxicity or mortalities in which a prescription opioid is believed to be a contributing factor.  And there hasn’t been for at least 10 years, despite continuing CDC misrepresentation of this issue.

Assertions of former CDC Director Thomas Frieden of a supposed cause-and-effect relationship between over-prescribing and the so-called "opioid crisis" were bogus as a three-dollar bill, even when he made them in 2016. Likewise, predetermined political agendas that drove the guideline writers are obvious in gross over-hyping of "risks" of opioid prescribing. CDC also ignored the wide variability in minimum effective doses and side effects between individual patients due to genetics. The 2022 guidelines mention genetics of metabolism just once and peripherally.

CDC has lost the public argument on health policy for treatment of chronic pain -- and with it, much of the credibility of the organization among both the public and professional clinicians. On the occasion of the departure of Rochelle Walensky from the organization, they have an opportunity to correct course and for once do the right things:

  • Repudiate and withdraw the 2016 and 2022 opioid guidelines.
  • Encourage the Veterans Administration to do the same.
  • Notify all State Medical Boards and Departments of Health that CDC documents should no longer be used as references for State regulatory policy on controlled substances.
  • Relinquish all future policy making roles in practice standards of pain medicine, in favor of clinician specialty academies supported by chronic pain patients and their knowledgeable advocates.

Absent these steps, a major house cleaning is long overdue among senior CDC staff. If they do not reform themselves, then legislators should do it for them -- to the applause of millions of doctors, patients and families harmed by CDC negligence and misdirection.

We Are A Nation In Pain and We Will Not Be Silenced!