A Compendium of 23 Papers Critical of US Public Health Policy on Pain Management and Ad

Abstract

This compendium is a collection of 23 papers critical of US public health policy on pain management and addiction. Prevailing 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. Arguably and by contrast, public health “authorities” are directly and personally responsible for thousands of negligent homicides and the near-destruction of US pain management as a field, growing from their intransigent advocacy of scientifically insupportable practice guidelines known before publication by authors and approving officials to be fatally flawed.

Methods: Critical review of published clinical literature with extraction of key findings.

Results: Taken in combination, the references offered in this mini-review support the conclusion that (a) public health policy prevailing in February 2025 is based on substantial anti-opioid bias that lacks supporting science and (b) multiple fatal flaws in the 2016 prescribing guidelines of the US Centers for Disease Control and Prevention (CDC), and in the 2022 updates to these guidelines and those of the US Veterans Administration were known to the authors and approving officials thereof before publication of those documents.

Background

As the author has written in some of the references below, US and international public health authorities and professional healthcare organizations are now engaged in a contentious public discussion of the causes and possible remedies for what has been termed “the Opioid Crisis”. De facto public policy is to discourage the use of prescription opioid analgesics, and their availability to patients – many of whom have proven records of safe and effective use for decades, with no evidence of prescription misuse or patient addiction.

However, there is ample evidence from multiple published sources to demonstrate that key assumptions of the US CDC, and Veterans Administration guidelines are factually wrong and deeply harmful to public health. Specifically: 1) It has been known for over 15 years that rates of treatment-related opioid addiction, overdose or death due to overdose are too small to measure accurately or predict in individuals. Papers published by anti-opioid zealots frequently ignore significant confounds in the documentation of individual overdoses, that invalidate diagnosis of “substance use disorder” as defined in the 5th edition of the Diagnostic and Statistical Manual of the American Psychiatric Association. 2) In the rare cases where patients under treatment with prescription opioid analgesics are hospitalized for opioid overdose, attempt or commit suicide, it is now known that the strongest predictors in patient medical records almost entirely relate to a history of severe mental health issues. 3) Published analysis of 40 years of accidental drug mortality data published by US CDC reveals that prescription drugs have never been the dominant factor in the US “opioid crisis”. When prescription drugs are found in post-mortem coroner and medical examiner reports, they are almost always accompanied by illegal opioids (primarily non-pharmaceutical Fentanyl), stimulants like Cocaine or Methamphetamine, and alcohol. Drugs prescribed by doctors to their patients did not cause and are not sustaining the high numbers of accidental deaths attributed to accidental drug overdose [1-23].

Discussion

Research compiled herein reflects 28 years of the author’s focused research as a healthcare writer and US National subject matter expert on the intersection of public health policy, pain medicine and addiction medicine. Papers reported here incorporate over a thousand references from clinical literature, and are in turn drawn from a searchable knowledge base of over 15,000 sources. This collection is arguably more wide-ranging and evidence-based than any other literature review published for this area of clinical practice.

It is intended that this compilation will be offered to multiple clinical journals and social media platforms for publication as a public service. These social media platforms serve and are read by over two million medical industry contributors: doctor, nurses, pharmacists, and mental health change agents. Republication in multiple reputable clinical journals is anticipated and invited. These references may also be useful as exhibits, for clinicians defending themselves in adversarial proceedings before US State Boards of Medicine, Pharmacy, or Nursing.

Conclusions

The compendium of published, evidence-based data and analysis offered above demonstrates that 2022 US CDC and Veterans Administration published guidelines on prescription of opioid analgesics in chronic severe pain do not represent a “consensus” of clinical opinion. Moreover, these guidelines are arguably fraudulent in that their authors and approving officials were aware before publication that the guidelines included substantial misinformation about the sources and risks of treatment-related addiction and mortality. These guidelines have been widely applied as a basis for falsely prosecuting clinicians who have done nothing harmful or wrong, in US State Medical Boards and/or law enforcement proceedings. Public repudiation and withdrawal of 2016 and 2022 CDC and VA prescribing guidelines without replacement are the only ethically sound measures open to public health authorities.

About the Author

Richard A Lawhern PhD is an independent healthcare writer and data analyst with 28-years’ experience and over 300 papers authored or coauthored in peer reviewed, editor reviewed, and mass media venues. None of the research reported in his published work has been funded. The author declares no financial or professional conflicts of interest.

References

• (2019) Frontline Physicians Call on Politicians to End Political Interference in Evidence Based Medicine. American Academy of Family Physicians. https://www.aafp.org/news/media-center/more-statements/physicians-call-on-politicians-to-end-political-interference-in-the-delivery-of-evidence-based-medicine.html
• Lawhern RA (2024) An Indictment of Us Public Health Policy on Pain Management. Clinical Medicine and Health Research Journal 4(6): 1031-1036. https://cmhrj.com/index.php/cmhrj/article/view/410/246
• Richard A Lawhern (2024) In Defense of Doctors Who Treat Pain--Questions and Answers for Judges, Juries... and Journalists. Clinical Medicine and Health Research Journal (CMHRJ) 4(4): 987-989. https://cmhrj.com/index.php/cmhrj/article/view/379/233
• L Joseph Parker (2023) The Persecution of Pain Management Doctors. Journal of Medicine, National Association of Medical Doctors. https://www.namd.org/journal-of-medicine/3104-the-persecution-of-pain-management-doctors.html

Seminal Papers and Literature Reviews

5. Stephen A Martin, Ruth A Potee, Andrew Lazris (2016) Neat, Plausible, and Generally Wrong: A Response to the CDC Recommendations for Chronic Opioid Use. https://medium.com/@stmartin/neat-plausible-and-generally-wrong-a-response-to-the-cdc-recommendations-for-chronic-opioid-use-5c9d9d319f71#.wzchd1kkl
6. Nora Volkow, A Thomas McMillan (2016) Opioid Abuse in Chronic Pain--Misconceptions and Mitigation Strategies. New England Journal of Medicine. 374(13): 1253-1263. http://www.nejm.org/doi/full/10.1056/NEJMra1507771
7. Cathleen London (2021) DOJ Overreach: The Criminalization of Physicians. Journal of Legal Medicine. 3(4): 191-203. https://doi.org/10.1080/01947648.2022.2147366
8. Larry Aubry, B Thomas Carr (2022) Overdose, opioid treatment admissions and prescription opioid pain reliever relationships: United States, 2010–2019. Frontiers in Pain Research. https://doi.org/10.3389/fpain.2022.88467
9. Michael E Schatman, Jeffrey Fudin (2016) The Myth of Morphine Equivalent Daily Dosage. Medscape. https://www.medscape.com/viewarticle/863477?form=fpf
10. Lawhern RA (2023) Resources for Clinicians in Pain Medicine: Correcting Medical Mythologies on Prescription of Opioid Analgesics. Medical Research Archives of the European Society of Medicine. https://esmed.org/MRA/mra/article/view/4860/99193547580
11. Stephen E Nadeau, Natalie J DelRocco, Samuel S Wu (2022) Opioid Trials: Time for a New Approach? Enriched Enrollment Randomized Gradual Withdrawal Designs. Pain Management 12(3): 243-247. https://pubmed.ncbi.nlm.nih.gov/35001667/

Integrated Treatment of Chronic Pain and Depression

12. Nadeau SE, Wu JK, Lawhern RA (2021) Opioids and Chronic Pain: An Analytic Review of the Clinical Evidence. Frontiers in Pain Research Front Pain Res. https://pubmed.ncbi.nlm.nih.gov/35001667/
13. Stephen E Nadeau, Richard A Lawhern (2022) Management of Chronic Non-Cancer Pain: A Framework. Pain Management 12(6): 751-777. https://www.tandfonline.com/doi/full/10.2217/pmt-2022-0017
14. Richard A Lawhern, Stephen E Nadeau (2024) Treating Pain and Anxiety-A Modest Proposal. Medical Research Archives of the European Society of Medicine. 12(6). https://esmed.org/MRA/mra/article/view/5359/

Papers on Addiction

15. Steven E Nadeau, Richard A Lawhern (2023) The Two Opioid Crises-Problems, Causes, and Potential Solutions: An Analytic Review. Medical Research Archives of the European Society of Medicine. https://esmed.org/MRA/mra/article/view/4846/99193547539
16. Lawhern RA (2023) Doctors Diagnosing Addiction-Are the Blind Leading the Blind? Medical Research Archives of the European Society of Medicine. https://esmed.org/MRA/mra/article/view/4726/99193547448

Papers Addressing Substantive Misdirection of Public Health Policy

17. Richard A Lawhern (2017) Figures Lie and Liars Figure-Why the Demographics of the So-Called. “Prescription Opioid Crisis” Don’t Work, “PainDoctor-The Blog of Jeffrey Fudin. https://paindr.com/figures-lie-and-liars-figure-why-the-demographics-of-the-so-called-prescription-opioid-crisis-dont-work/
18. Richard A Lawhern (2023) Oversight on Revision of US CDC Guidelines: A Process Pre-Destined to Fail. Nursing and Hospital Care 7(5): 1-10. https://www.scivisionpub.com/pdfs/oversight-on-revision-of-us-cdc-opioid-guidelines-a-process-pre-destined-to-fail-2988.pdf?fbclid=IwAR29QSjcNr14RK9H9tFIRHe9BqGHrpnTyC0Ac1H--w5xIMlR2r5yUR144hk
19. Richard A Lawhern (2024) The Real Opioid Crisis in Three Charts-An FDA Listening Session. posted to Linked In.
20. Richard A Lawhern (2023) Everything the Government Thinks It Knows About the Opioid Crisis is Wrong. KevinMD. https://www.linkedin.com/pulse/real-opioid-crisis-three-charts-fda-listening-session-lawhern-qkc4c
21. Jeffrey Miron, Greg Sollenberger, Laura Nicolae (2019) Overdosing on Regulation-How the Government Caused the Opioid Epidemic. Cato Institute. https://www.kevinmd.com/2023/07/everything-the-government-thinks-it-knows-about-the-opioid-crisis-is-wrong.html
22. Monty Goddard (2023) A Two-Headed Monster-State Attorneys General and the Drug Enforcement Agency. Daily Remedy. https://www.kevinmd.com/2023/07/everything-the-government-thinks-it-knows-about-the-opioid-crisis-is-wrong.html
23. Pat Irving RN (2023) The National Opioid Settlement is Causing Drug Shortages. Pain News Network. https://www.painnewsnetwork.org/stories/2023/9/11/the-national-opioid-settlement-is-causing-drug-shortages