Recommended Reading for Peer Reviewers of the 2022 Revised CDC Guidelines on Prescription of Opioids in Acute and Chronic Pain

Recommended Reading for Peer Reviewers of the 2022 Revised CDC Guidelines on Prescription of Opioids in Acute and Chronic Pain

Posted by Email

For Administrators, Board of Scientific Counselors

National Center for Injury Prevention and Control

Please pass to all BSC members

Also transmitted to Executive Secretary, CDC

For the Director and Senior Staff

CC: Stephen E Nadeau MD

BCC: ~350 Medical professionals, patient advocates, lawyers, and media reporters

This note is to share a resource that I believe should be made available to all peer reviewers of the proposed 2020 revised and expanded CDC Practice Guidelines on prescription of opioids in acute and chronic pain. The following paper incorporates and discusses over 120 references that apply directly to these revised guidelines.

https://www.frontiersin.org/articles/10.3389/fpain.2021.721357/full

As of February 16, 2020, it has been six months since this paper was published. It has received over 26,000 views and more than 1,000 downloads. It has been cited twice (it usually takes a year or more for citations to start to appear). And one derivative paper has been published -- an important one and in a PubMed listed journal.

I realize that the writers of the CDC guidelines revision are unlikely to read this resource, given their rampant anti-opioid biases and prejudices. But I implore more responsible policy makers to overcome such willful blindness and READ! The following is an abstract for those who consider themselves too busy with other matters.

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We conducted an analytic review of the clinical scientific literature bearing on the use of opioids for treatment of chronic non-cancer pain in the United States.

There is substantial, albeit not definitive, scientific evidence of the effectiveness of opioids in treating pain and of high variability in opioid dose requirements and side effects.

The estimated risk of death from opioid treatment involving doses above 100 MMED is ~0.25%/year.

Multiple large studies refute the concept that short-term use of opioids to treat acute pain predisposes to development of opioid use disorder.

The prevalence of opioid use disorder associated with prescription opioids is likely <3%.

Morbidity, mortality, and financial costs of inadequate treatment of the 18 million Americans with moderate to severe chronic pain are high.

Because of the absence of comparative effectiveness studies, there are no scientific grounds for considering alternative non-pharmacologic treatments as an adequate substitute for opioid therapy but these treatments might serve to augment opioid therapy, thereby reducing dosage.

There are reasons to question the ostensible risks of co-prescription of opioids and benzodiazepines.

As the causes of the opioid crisis have come into focus, it has become clear that the crisis resides predominantly in the streets and that efforts to curtail it by constraining opioid treatment in the clinic are unlikely to succeed.

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I request the courtesy of a substantive reply by any or all of the "to" addressees to this letter , not later than February 28th. Your response will be shared separately with the BCC addressees and discussed in broadcast media that reach hundreds of thousands of US citizens.

Sincere best regards,

Richard A "Red" Lawhern PhD

Patient Advocate