A Reviewer’s Analysis of the Draft CDC Guidelines

A Former Federal Peer Reviewer’s Analysis of the Draft CDC Guidelines | National Pain Report | December 30, 2015 | Brooke Lee Keefer

In my former life prior to chronic pain and illness I had many important and fascinating jobs.  One was as a peer reviewer for the United States National Institutes for Health (NIH), Center for Mental Health Services (CMHS), and Substance Abuse and Mental Health Services (SAMHSA)

The guideline is not organized like a typical guideline or tool kit.  It is nothing more than a literature review of the harms and risks of opioids.  It is not objective, therefore, I found it impossible to be objective.

Reading this document left me scared—really scared.  It left me wondering what happened to the United States and to the rights of patients?  How could this be?  No consumer groups or chronic pain patients were included in their peer review or “experts” process.  A huge no no.  

Here is the comment I posted on the CDC site:  

It is imperative a section in the guideline be created detailing how adequate pain control is a fundamental right of every patient.

Preventing drug abuse is an important societal goal, but it should not hinder patients’ ability to receive the care they need and deserve” (http://www.deadiversion.usdoj.gov/pubs/advisories/painrelief.pdf).  In addition, in this section provide a thorough review of the risks of untreated chronic pain, i.e. suicides, depression, unemployment, lower quality of life, etc.

Throughout this document it is mentioned there are no adequate long term studies that prove opioid medication is effective…

Here, I’d like to remind everyone that there are no adequate long term studies that prove opioid medication is NOT effective – no long term studies at all.

…leading the reader to believe opioid medication never helps patients long term, which is not true.

It became clear to me this document was written in a biased manner when I read the “Effectiveness of Alternative Treatments” section.  It boasted these treatments effective under 6 months.  

Nowhere in this document did I see a similar positive citation for opioid treatment for short term use though hundreds exist.

The writers excluded the fact these alternative treatments, like opioids, had no proven long term benefits

Furthermore, the alternative pharmacological agents, i.e. gabapentin, SSRIs, NSAIDs, etc. are touted as excellent treatments with little to no risks.  The writers should have included information on the hundreds of possible side effects, some very serious, each of these drugs carry.

The statistics in the Background section do not delineate criminal activity from actual chronic pain patients in a pain management type setting.  It also does not define whether there were additional drugs or alcohol contributing to the overdose (polydrug overdose) and whether these overdoses were legitimate pain patients or illegally obtained prescriptions.

This is not a paper about criminal activity and misuse.  Only statistics for actual pain patients should be included.

Include information on the difference between physical dependence, tolerance, and addiction/misuse of opioid medications.

See my page “Addiction, Dependence, and Tolerance”

Information about actual pain conditions is slim, which is disconcerting.  The fact you include cataracts as a painful condition and not severely painful conditions shows the lack of familiarity of the team of writers with true chronic pain populations.

The CDC is clearly not the appropriate agency to spearhead opioid prescribing guidelines.  They are good at authoring literature reviews on ebola and trying to find cures for diseases.  They are NOT equipped to publish guidelines of this manner.  This is not an epidemic and they are incapable of being objective.  A document like this must be objective and unbiased.