Richard Lawhern

This project traces the US national impact of prevailing trends in healthcare cost and the increasingly widespread denial of medical treatment by US healthcare insurance companies.

In December 2019, the US Centers for Disease Control and Prevention (CDC) announced their intention to review and revise their 2016 Guideline on Prescription of Opioids to Adults. As a part of this revision, CDC solicited self-nominations for an advisory “Opioid Workgroup” to report to the Board of Scientific Counselors of the National Center for Injury Prevention and Control. This paper offers a critical review of concerns identified in the final Workgroup report of July 2021, as contrasted against the revised and expanded CDC guidelines published 16 months later in November 2022. The author finds that although the Workgroup was tasked to identify substantive issues, its input to CDC was largely marginalized or ignored in the revised guidelines. The Workgroup also failed to reach consensus on central issues of methodology, which should disqualify the CDC guidelines as a de factor standard of clinical practice. Arguably, the CDC should be removed from all further participation in development of public policy for the treatment of severe pain.

This compendium offers a collection of 23 papers critical of US public health policy on pain management and addiction, from multiple authors and sources. Prevailing public health policy has harmed millions of US clinical patients and healthcare providers. Two profound and interactive issues are addressed: a) Literally everything that the US and most State governments think they know about the so-called “opioid crisis” is provably wrong from published contradictory evidence -- on grounds of both science and medical ethics. b) Misdirected public health and law enforcement policy on pain and addiction treatment are directly responsible for thousands of patient suicides and the malicious prosecution and imprisonment of hundreds of clinicians who are in fact guilty of no crime. Public health “authorities” are directly and personally responsible for thousands of negligent homicides and the near-destruction of US pain management as a field. This result grows from their intransigent advocacy of scientifically insupportable practice guidelines known before publication by CDC and AHRQ authors and approving officials to be fatally flawed.

This short paper offers evidence of bias on the part of editors and peer reviewers of the New England Journal of Medicine, in their refusal to permit a reasoned response to scientifically invalid claims on the part of anti-opioid zealots, previously published by NEJM. In six pages, major findings are communicated in language accessible to lay readers, concerning the use of prescription opioids in clinical practice. This narrative substantively debunks the assertions of advocacy groups such as "Physicians for Responsible Opioid Prescription" (PROP). (Article co-authored with Stephen E Nadeau, MD)

[26 pages, 165 references] This analytic review of scientific, socioeconomic and historical literature describes the evolution and causes of two opioid crises in America: (1) an evolved crisis currently manifesting as widespread abuse of illicit opioids (street drugs), and (2) a crisis in clinical pain management largely manufactured by the US Centers for Disease Control and Prevention 2016 Guidelines on prescription of opioids to adults with chronic pain. Key findings of this review include the reality that factors in patient mental health history are from five to twenty-three times more important in predicting risk of patient overdoses, attempted or successful suicide within one year, than is exposure to prescription opioids as such. This reality was ignored in the 2016 (and 2022) CDC opioid prescribing guidelines. For multiple reasons, we conclude that the US CDC should have no future role in the regulation of patient care for other than communicable disease.

Again, in language accessible to lay readers, the case is made that patients are dying and doctors are languishing in prison, as (figuratively) blind men and women on the senior staffs of US healthcare and law enforcement agencies argue over the dimensions of the elephant in their room. Professionals seem to be operating within a framework of political belief and bias, not science. Nobody seems to be talking with practitioners in disciplines other than their own. This is institutionalized madness. And it is time for it to stop.