by Myra Christopher, Director of PAINS

Could this mark a new era?

On February 15th, the Duke Margolis Center for Health Policy released a landscape analysis of strategies being used by US health system stakeholders to support safe and appropriate prescribing of opioids. The work was contracted by the FDA and included a qualitative systematic review of “white (PUBLINE) and grey literature” including:

  • Provider association reports
  • Statements and letters
  • News media
  • Industry press releases
  • State budget and policy documents
  • Other publicly reported information

Interviews were also conducted with more than 50 policy and health system experts. I was pleased to be included in their process and to also be invited to speak at a day-long meeting at the National Press Club which coincided with the release of the report “Strategies for Promoting the Safe Use and Appropriate Prescribing of Prescription Opioids.”

Those of us who participated in the workshop received an embargoed copy of the report two days before the meeting. I have been eager to share it with PAINS Update readers ever since and encourage you to go to, read it carefully, and share your thoughts about it with those at the Duke Margolis Center who worked on the report .

Upon reading the draft report, I concluded that this report can serve as a bridge between those advocating for people with chronic pain and others advocating for people struggling with substance use disorders, including opioid addiction. The meeting intensified my enthusiasm for the impact this report can have IF there is further dialogue and IF collaborative policy efforts can ensue.

The 2011 Institute of Medicine report, Relieving Pain in America, called for a public health approach to the problem of inappropriately and under-treated pain. Likewise, the Duke Margolis Center report calls for “A Comprehensive Public Health Approach to the Opioid Epidemic,” including:

  1. Public Education
  2. Safe and Appropriate Opioid Prescribing
  3. Support for Substance Use Disorder Treatment and Recovery
  4. Overdose Prevention

The tone of the meeting was positive, and the overlap between these recommendations and those contained in the National Pain Strategy provide common ground for collaboration.
Many things that happened during the workshop made me hopeful about this possibility, especially:

  • FDA Director Scott Gottlieb’s careful framing of the problem—his resistance to hyperbole and unsubstantiated data that have often been included in such meetings
  • FDA Epidemiologist Judy Staffa’s presentation calling for improved metrics to evaluate unintended consequences of the CDC Guideline on Opioid Prescribing for Chronic Pain, including quality of life measure
  • American Society of Addiction Medicine President Kelly Clark’s call for clarity about language and the importance of distinguishing opioid dependence from addiction

It was my privilege to include in my presentation photos of and brief biographical information about four members of the PAINS-KC Citizen/Leader Advisory Group and to claim that I wished to speak on behalf of the millions of Americans who live with chronic pain, especially those who live with what has been labeled “high-impact chronic pain.” Again I encourage readers of this report to visit and watch part or all of the workshop and to read the report in its entirety. Should anyone wish to read my remarks, we will be glad to email a copy to you.

Let me conclude by saying that it is past time for those of us concerned about people struggling with serious chronic illness—whether substance use disorder/opioid addiction or chronic pain—to stop thinking of ourselves as on opposite “sides” of this important public health “debate.” In fact, I think we should avoid the term “debate” altogether. Debate implies winners and losers. Debate implies a certain amount of gamesmanship and strategizing to get the upper hand. The most important strategy I can think of is utilizing the Duke Margolis Center report to find common ground and to begin actively searching for ways to work together to improve the health and well-being of millions of Americans who need compassionate quality care.