What should Trump look for in a new CDC director?
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President-elect Trump's new Centers for Disease Control and Prevention (CDC) director must recognize that the pain epidemic should be as much a priority as solving the opioid epidemic.

Tom Frieden, MD, MPH recently announced his resignation as CDC director. Under his leadership, the CDC addressed many public health challenges including the Ebola virus, Zika virus, and the opioid crisis.

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But perhaps there hasn’t been anything more controversial in recent times from the CDC than the development of opioid prescribing guidelines intended to discourage the use of opioids to treat chronic non cancer pain.

Frieden recognized the severity of the crisis, and he did what his advisory panels recommended. However, the advisory panels have been criticized for biases and conflicts of interest.

In a Dec. 2, 2015 letter to Dr. Frieden, the Chairman of the House Committee on Oversight and Government Reform, Rep. Jason ChaffetzJason ChaffetzElijah Cummings, Democratic chairman and powerful Trump critic, dies at 68 House Oversight panel demands DeVos turn over personal email records The Hill's Morning Report - Presented by JUUL Labs - Trump attack on progressive Dems draws sharp rebuke MORE (R-Utah), expressed concern that the guidelines "may be insufficient to treat those suffering from chronic pain."

He went on to say that he expected the guidelines "to seek an appropriate balance between the risk of addiction and the need to address chronic pain.” The letter further questioned the process and composition of the experts used by the CDC to develop the guidelines.

Others were also concerned about the process and outcome of arriving at the guidelines. For example, Sharon Hertz, who serves as director of the FDA’s Division of Anesthesia, Analgesia and Addiction Products, said, “I think we need to recognize that CDC wants to substantially limit opioid prescribing. Period.”

Hertz appears to be correct. Frieden recently told the Los Angeles Times that the opioid crisis is driven by overprescribing. Unquestionably, this is a factor. But his statement demonstrates an insufficient understanding of the problem and ignores the need for balance expressed by Rep. Chaffetz.

Frieden is not alone in blaming prescription opioids for the opioid crisis. President Barack ObamaBarack Hussein ObamaLGBTQ advocates slam Buttigieg for past history with Salvation Army Jayapal pushes back on Gaetz's questioning of impeachment witness donations to Democrats Gaetz clashes with Stanford professor: 'It makes you look mean' MORE, in the January issue of Harvard Law Review, writes, "As their [prescription opioids] use has increased, so has their misuse.”

To combat the opioid epidemic, Obama has focused exclusively on overprescribing and treatment of addiction. He explains that his Administration "has worked to combat this [opioid] epidemic through targeted enforcement activities; funding new and unprecedented networks of law enforcement and public health partnerships to address the heroin threat; targeting heroin and prescription opioid traffickers and the illegal opioid supply chain; and thwarting doctor-shopping and disrupting so-called 'pill mills.' "

Surprisingly, the president did not acknowledge that there are millions of Americans with severe pain who do not have options for pain relief except from opioids.

As if choreographed to support the CDC's efforts, the U.S. Surgeon General Dr. Vivek H. Murthy sent a letter in the late summer of 2016 to 2.3 million American health professionals asking them to pledge to follow the guidelines as part of his Turn the Tide campaign.

The consequences of the opioid guidelines have exacerbated a conflict within the medical community that has pitted doctors and others who advocate for people with pain against medical professionals who exclusively are concerned about preventing opioid addictions.

The new CDC director could start by recognizing the dual crises of pain and addiction and that insurance companies are a major reason why there has been overprescribing.

Pain patients have been denied coverage for even the evidence-based alternatives to opioids recommended by the CDC, thereby forcing more people to use prescription painkillers to find relief of severe pain.

Additionally, the new director should recommend to Congress that payers be mandated to provide a minimum set of health insurance benefits for people with chronic pain that includes coverage of effective alternatives to opioids. The pain community made this recommendation to the CDC, but unfortunately, it has not been acted upon.

Overprescribing of opioids has occurred because of a need to treat pain rather than to allow unmitigated suffering. The new CDC director’s solutions to the opioid crisis must include new and expanded pain education. Medical schools should provide more than just addiction training, as was proposed by the Obama Administration.

However, the most important recommendation that the new CDC director should make is to support more funding through the National Institutes of Health to discover safer, more effective alternatives to opioids for the treatment of severe pain disorders.

It is important that the new CDC director acknowledge the truth of the Institute of Medicine's 2011 report, Relieving Pain in America, A Blueprint for Transforming Prevention, Care, Education and Research, which says that there are 100 million Americans with chronic pain. As the leading governmental agency responsible for improving the public health of all Americans, it would seem that improving the lives people in pain should be a priority for the CDC and the new administration.

President Obama and Dr. Frieden recognized the gravity of the opioid crisis, and they helped call the public's attention to the problem. Under the leadership of President Trump, perhaps we can choose a CDC director who will steer a course toward reducing overdose deaths while also considering the needs of people in pain.

Lynn R. Webster, MD is Vice President Scientific Affairs for PRA Health Sciences. He is a past President of the American Academy of Pain Medicine. In addition, he is the author of the award winning book, “The Painful Truth: What Chronic Pain Is Really Like and Why It Matters to Each of Us” (Oxford University Press). Visit him online at www.thepainfultruthbook.com. @LynnRWebsterMD

 


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