Just a quick e-mail update about the CDC meeting
What was the meeting about? As many of you know, the 2016 CDC Guidelines for opioid prescribing are being updated and or/expanded. The final guidelines are due to be released by the end of 2022. On Friday July 16, 2021, the CDC National Center for Injury Prevention and Control (NCIPC) held an all-day meeting.
Last year, an Opioid Work Group (OWG) was formed with the goal of reviewing the draft of the updated guidelines and providing feedback. The OWG report was released on July 15, 2021, and shows comments about each suggested guideline. Also, there is commentary on the evidence rating of each guideline. The evidence rating is done as follows:
Evidence is categorized into four types within the GRADE framework:
Type 1, or high-quality evidence: Randomized controlled trials (RCTs) or overwhelming evidence from clinical studies
Type 2, or moderate-quality evidence: RCTs with important limitations, or exceptionally strong evidence from observational studies
Type 3, or low-quality evidence: Observational studies or RCTs with notable limitations
Type 4, or very low-quality evidence: Clinical experience and observations, observational studies with important limitations, or RCTs with several major limitations
Each guideline is given either A or B category designation.
Category A recommendations apply to all patients.
Category B recommendations require individual decision making where different choices will be appropriate for different patients so that clinicians must help patients arrive at a decision consistent with patient values and preferences and specific clinical situations.
Based on the OWG report, 11/12 recommendations were given a Category A, and 1 was given B. One was given 2, five were given 3. and 6 were given 4. The only one given type 2 evidence rating was about OUD, not pain. In other words, the guidelines have low-quality to very low-quality evidence, yet they recommend they be applied to everyone. This is important for us to understand because they are always referred to as “evidence based guidelines."
What was the outcome of the meeting? The Board of Scientific Counselors (BSC) voted to endorse the OWG report
What does this mean for our community?
Well, it is a win for our community. When you read the report, you will see that many of the comments were about how these guidelines could be misapplied, how they vilified opioids, and didn’t discuss the benefits of them. It doesn't necessarily mean the finalized updated guidelines will be changed for the better, but it's a start. Let’s break this down to two big take-aways from this meeting.
Roger Chou (a co-author of the 2016 CDC Guidelines, the updated CDC Guidelines, and a member of the BSC) recused himself from the meeting. Will this help us? Only time will tell! His exact words were “I do have a conflict of interest that I received funding to conduct reviews on opioids and I’ll be recusing myself after the director’s update." Check out these tweets from Carrie Judy, a fellow CPP advocate who spends endless time researching with us. Carrie summed it up perfectly about Roger Chou...“he chooses which studies are considered to go into the guidelines, he writes them, and then gets to approve them.”
The issue with MME was discussed. MME means Milligram of Morphine Equivalent. It is a way of determining strength of opioid doses. As we know, 90mme was a threshold created for the CDC Guidelines, and one to which many people have been tapered. A few weeks ago, there was an FDA presentation by Dr. Nabarun Dasgupta explaining that MME isn’t scientific at all, and it shouldn’t be used as a threshold. At the end of the meeting, the BSC actually discussed this issue saying maybe they shouldn’t have an MME in the guidelines at all. That would be a huge win for us!
Our voices were heard! Most of the callers were pain patients or pain doctors who were vocal about how the CDC Guidelines have hurt our community!
***HERE IS WHERE YOU COME IN***
What can you do to help?
E-mail the CDC at NCIPCBSC@CDC.gov with your comment about the CDC Guidelines. Read the OWG report and comment accordingly. Let them know how the CDC Guidelines have affected your life. All comments will be read and taken into account. Deadline is July 23, 2021
Donate – Your donations allow us to pay for lobbyists and continue to dedicate our time to get this information out to you!
Winner of the NASTIEST statement award goes to none other than Roger Chou: “I can’t tell you whether the tapers I do in my practice are voluntary or involuntary...the majority of the time, patients don’t want to be tapered." Chou questioned whether the task force should use the terms patient-centered or compassionate.
WHEW! That was a lot of information in one e-mail update! Please feel free to contact Claudia or Bev with any questions you have! We are here fighting for and with you!