2019 Opioid Workgroup

The Federal Advisory Committee Act (Public Law 92-463), often referred to as “FACA”, provides a mechanism for experts and stakeholders to participate in the decision-making process, by offering advice and recommendations to the federal government as members of federal advisory committees. A federal advisory committee is defined as any committee, board, commission, council, conference, panel, task force, or other similar group, which is established by law, by the President, or by an agency official, and utilized to provide advice or recommendations to the President or the agency, on issues or policies within the scope of an agency’s responsibilities. Federal advisory committees must be engaged when federal agencies, such as the Centers for Disease Control and Prevention (CDC), seek consensus advice and recommendations from non-government individuals. Federal advisory committees are a key component of CDC’s overall strategy to achieve stakeholder and public engagement in its efforts and commitment to improve people’s health.

The Board of Scientific Counselors of the National Center for Injury Prevention and Control (BSC/NCIPC) is one of the federal advisory committees of the Centers for Disease Control and Prevention. The BSC/NCIPC advises the Secretary, U.S. Department of Health and Human Services; the Director, CDC; and the Director, National Center for Injury Prevention and Control (NCIPC), regarding surveillance, basic epidemiologic research, intervention research, and implementation, dissemination, and evaluation of promising and evidence-based strategies for the prevention of injury and violence. The BSC/NCIPC makes recommendations regarding policies, strategies, objectives, projects, and priorities and reviews progress toward injury and violence prevention.

The Board of Scientific Counselors of the National Center for Injury Prevention and Control (BSC/NCIPC) voted unanimously on December 4, 2019, to establish an Opioid Workgroup (OWG). The primary purpose of the OWG is to review a draft Guideline for opioid prescribing (as prepared by CDC) and to develop a report that will provide the workgroup’s findings and observations about the draft Guideline to the BSC/NCIPC. In accordance with Federal Advisory Committee regulations, workgroups do not make decisions or provide recommendations. The BSC/NCIPC will subsequently review the OWG’s report, discuss, deliberate, and provide advice and recommendations for CDC to consider as part of the Guideline update process. The workgroup will help ensure broad, external, transparent input on the diverse and complex issues involved in this effort.

The Opioid Workgroup (OWG) of the Board of Scientific Counselors of the National Center for Injury Prevention and Control (BSC/NCIPC) is actively engaged in its established purpose to review a draft of the updated CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016 (as prepared by CDC) and to develop a report that will provide the workgroup’s findings and observations about the draft guideline to the BSC/NCIPC. The OWG reports to the BSC/NCIPC, one of the federal advisory committees of the Centers for Disease Control and Prevention.

CDC announced the OWG members at the publicly held BSC/NCIPC meeting on July 22, 2020. The Opioid Workgroup Roster is available here. The OWG had a total of 11 meetings from October 2020 through June 2021.

The OWG’s first meeting in October 2020 included a review of the OWG Terms of Reference and an orientation to workgroup operations. The OWG also received a presentation on the rationale for the 2016 Guideline’s creation, highlighting recommendations and describing results following implementation of the Guideline.

The November 2020 OWG meeting included a review of the processes used to gain community perspectives and insights and a description of emergent themes from the Federal Register Notice, Management of Acute and Chronic Pain: Request for Comment, and the Federal Register Notice, Management of Acute and Chronic Pain: Opportunity for Stakeholder Engagement. To better understand the lived experiences and perspectives of community members that we serve, CDC posted two notices in the Federal Register to learn more about values and preferences related to pain and pain management options (including but not limited to the benefits and harms of opioid use) to complement ongoing Guideline update efforts. CDC received 5,392 public comments on the first Federal Register Notice (FRN) (from 4/17/20-6/16/20). For the second FRN (from 7/22/20-8/21/20), CDC invited patients with acute or chronic pain, patients’ family members and/or caregivers, and clinicians who care for patients with pain or conditions that can complicate pain management (e.g., opioid use disorder or overdose) to apply for the opportunity to participate in an individual conversation about their experiences with pain and pain management. After the FRN closed, participants were randomly selected within each group (i.e., patients, caregivers, clinicians) from a total of 973 respondents. Telephone and video conversations were conducted throughout September 2020 with 106 individuals, which included 42 patients, 21 caregivers, and 43 clinicians. CDC reviewed thematic summaries of public comments and individual conversations to learn more about patients’, caregivers’, and clinicians’ values and preferences before drafting the updated guideline.

The OWG’s February 2021 meeting topic was an overview of Grading of Recommendations Assessment, Development and Evaluation, also known as GRADE. This meeting focused on understanding the strength of a recommendation as it relates to the quality of evidence. The OWG also received the recent Agency for Healthcare Research & Quality systematic reviews on chronic and acute pain for specific patient populations. These reviews include new evidence related to the treatment of chronic and acute pain:

• Noninvasive Nonpharmacological Treatment for Chronic Pain (An Update)
• Nonopioid Pharmacologic Treatments for Chronic Pain
• Opioid Treatments for Chronic Pain
• Treatments for Acute Pain: A Systematic Review
• Acute Treatments for Episodic Migraine

In March 2021, the OWG met and began reviewing a draft Guideline for opioid prescribing (as prepared by CDC). They held 7 virtual meetings from April through June 2021 to review the draft Guideline and develop a report that provides the workgroup’s findings and observations about the draft Guideline. This report will be presented to the BSC/NCIPC at a public meeting on July 16, 2021 and will be posted on the BSC/NCIPC website prior to the start of the meeting. There will be a two-hour public comment period at this meeting from 2:15 p.m. to 4:15 p.m., EDT. In addition, individuals can submit written comments on or before July 23, 2021. More information about this meeting can be found in the Federal Register Notice.

Following engagement of the BSC/NCIPC, it is anticipated that a revised Guideline will be posted in the Federal Register for public comment in early 2022. Release of a final updated Guideline is anticipated to occur in late 2022.

The Opioid Workgroup (OWG) of the Board of Scientific Counselors of the National Center for Injury Prevention and Control (BSC/NCIPC) is made up of 23 people. In accordance with CDC guidance, at least two members of the parent committee (BSC/NCIPC) must be appointed as workgroup members (OWG). The chair of the OWG is an appointed BSC/NCIPC member. OWG members include patients with chronic pain, caregivers, and family members of patients with chronic pain. The OWG also comprises clinicians and subject matter experts, with the following perspectives represented: primary care, pain medicine, public health, behavioral health, pharmacy, emergency medicine, medical toxicology, obstetrics/gynecology, bioethics, orthopedic surgery, plastic surgery, dentistry, sickle cell disease, substance use disorder treatment, and research. Diversity in perspectives is also represented in regard to sex, race/ethnicity, and geographic region. Federal partners serve as ex-officio members of the OWG and include representatives from the National Institute on Drug Abuse at the National Institutes of Health, the Substance Abuse and Mental Health Services Administration, the Food and Drug Administration, and the Indian Health Service. The OWG has a Designated Federal Officer (DFO) that is a subject matter expert from the National Center for Injury Prevention and Control (NCIPC).

CDC presented the OWG roster and reviewed the Terms of Reference at the publicly held BSC/NCIPC meeting on July 22, 2020. The OWG Roster is available here.

To serve as a member of the Opioid Workgroup of the Board of Scientific Counselors of the National Center for Injury Prevention and Control, nominees were instructed to email their curriculum vitae and current contact information to NCIPCBSC@cdc.gov on or before Tuesday, February 4, 2020.

In seeking a balance of perspectives among prospective Opioid Workgroup members, the Centers for Disease Control and Prevention (CDC) has ensured inclusion of audiences directly affected by the CDC Guideline for Prescribing Opioids for Chronic Pain —United States, 2016, audiences that would be directly involved in implementing or integrating updated or expanded recommendations into current practice, and audiences qualified to provide representation of a specific discipline or expertise in alignment with the tasks of the workgroup.

Perspectives‡^¶* of prospective Opioid Workgroup members that support or enhance the workgroup’s capacity to complete tasks include, but are not limited to, those of the following groups (and was balanced with considerations including workgroup size).

In alphabetical order, groups include:

• Clinicians
• Dentists
• Ethicists
• Patients and Families*
• Pharmacists/Pharmacologists
• Primary care clinicians
• Public health practitioners
• Research scientists
• Surgeons

‡ Given workgroup factors including size considerations, prospective members who offer two or more perspectives was desired.

^¶ CDC will exercise discretion, consistent with federal advisory committee management requirements, regarding the appointment of workgroup member.

* Perspectives will be sought to represent those of people experiencing benefit, harm, or both related to opioids prescribed for pain.

The process for forming the Opioid Workgroup included the following tasks of the Designated Federal Officer.

• Developed a list of prospective workgroup members (informed by sources including comments from BSC/NCIPC members during the December 4–5, 2019 public meeting and complete self-nominations received on or before February 4, 2020).
• Requested and reviewed nominees’ disclosures of competing conflicts of interest, if any.
• Developed a list of prospective Opioid Workgroup members, ensuring maximal breadth of expertise and diversity in perspectives.

Updated the BSC/NCIPC on the formation of the Opioid Workgroup at the July 2020 meeting; this public meeting was announced in the Federal Register.

Opioid Workgroup members will provide clinical and methodologic feedback on evidence reviews and an updated draft of the CDC opioid prescribing guideline. The Opioid Workgroup will provide a report summarizing the expert input/observations/findings obtained and present the report for BSC/NCIPC deliberation, discussion, modification and decision at a public meeting which will be announced in the Federal Register.

During a public meeting of the Board of Scientific Counselors of the National Center for Injury Prevention and Control (BSC/NCIPC) that will include public comment opportunities, the BSC/NCIPC members will review the Opioid Workgroup’s report and discuss, deliberate, and provide advice and recommendations regarding a possible updated or expanded draft opioid prescribing guideline to the Secretary, U.S. Department of Health and Human Services; the Director, Centers for Disease Control and Prevention (CDC); and the Director, the National Center for Injury Prevention and Control (NCIPC).  Following the public meeting, the report of the Opioid Workgroup will be posted on the BSC/NCIPC website. Revision of the updated draft guideline will be informed by the recommendations of the BSC/NCIPC and public comment during the BSC/NCIPC meeting. It is anticipated that a revised guideline will be posted for public comment early 2022. Release of a final updated guideline would be anticipated to occur in late 2022.

Presentations related to the background and update on the formation of the Opioid Workgroup are available here.  Presentations from future BSC/NCIPC public meetings will also be posted on this site as they become available.

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