Pain Management Task Force: Secretary Alex Azar’s Opening Remarks


Thank you all for joining us today for this
important inaugural gathering and thank you for your service on this very critical mission. I’d like to especially thank our Assistant
Secretary for Health, Admiral Giroir, and Charmaine Yoest from the Office of National
Drug Control Policy for joining us today. This task force has a very important job before
it, and the broad composition of the members here today speak to that: We have prescribers;
pharmacists; dentists; patient advocates; experts on pain, mental health, and addiction;
and representatives from state medical boards, hospital associations, and veterans and military
organizations. All of these constituencies, inside and outside
the federal government, have a role to play in the work of improving pain management in
America. This interagency task force was authorized
by the Comprehensive Addiction and Recovery Act of 2016, or CARA. CARA was one of the first major legislative
efforts to address opioid addiction in America. It attracted broad bipartisan support, and
created new HHS grant programs to help reduce drug overdoses and expand access to addiction
treatment. Through measures like establishing this committee,
Congress’s work on CARA also recognized that we cannot solve this crisis just by addressing
its downstream effects. We have to attack the problem at its root
by looking at the intersections of mental health, addiction, and pain, and better understanding
how a lack of quality pain management has led to the overprescribing of legal opioids. The number of opioid painkillers prescribed
in America rose more than 230 percent from 1999 through 2012. Since 2012, thanks to efforts taken everywhere
from the federal level on down to individual physicians, the amount of opioids prescribed
has been decreasing. Yet in 2015, we still prescribed about three
times as many opioids as we did in 1999, and we still prescribe four times more the number
seen in Europe. Now I don’t think that pain has tripled or
quadrupled from Europe and yet we still are where we are. Many of us know how we got here: Where physicians
once worried about the addictive potential of opioid painkillers, a conventional wisdom
arose that the risk of abuse was very low, and that physicians should get used to the
idea of regularly prescribing opioids for all kinds of pain. Doctors were told, for instance, that pain
should be treated as a fifth vital sign, and that patients should be constantly asked if
their pain was being adequately treated. As a recent inpatient of America’s hospital
system I can assure you that to this day you are constantly asked about your pain level
and where you are on that level and even putting it up on a white board in your room, what
your pain level is. And what your pain goal is. Compensation and quality rating systems assessed
how happy patients were with their pain treatment, driving doctors to overprescribe out of concern
that their compensation or quality scores might get dinged. This shift also undermined good work being
done to manage pain holistically, through physical therapy, non-opioid pharmaceutical
options, stress reduction, and other methods. In 1998, one assessment found that there were
more than a thousand multidisciplinary pain clinics across the country by 2005, there
were just 85. Part of the appeal of opioid pills was not
that they were effective, but that they were cheap, and covered by insurance and easy to
prescribe. With limited time to assess often complex
patients, physicians often found pills the quickest option, too. Of course, as we’ve belatedly realized, these
pills are tremendously addictive 60 percent of America’s new heroin users, for instance,
have already misused legal opioids. The rising supply of these addictive pills
has combined with lack of addiction treatment capacity to create the worst drug crisis in
American history: more than 40,000 deaths from opioid overdoses each year. Your work is a part of broader efforts across
HHS and the federal government to stop that crisis. One of the five pillars of the HHS strategy
for the opioid crisis is advancing the practice of pain management. Further, one of the three goals of the Trump
administration-wide strategy rolled out earlier this year to reduce the opioid supply by cutting
inappropriate prescribing. So this task force will play an important
role in confronting the opioid crisis but you also must focus on another challenge:
helping us properly treat the real problem of pain in America. Our understanding of pain is constantly advancing
and in many cases, we are learning that opioids can be not just dangerously addictive, but
also no more effective than other options. The work of this task force, which Admiral
Giroir will detail more in a moment, is to ensure that federal best practices for pain
management are consistent and up-to-date. Earlier this year, I appointed Admiral Giroir
to be my Senior Adviser for Opioid Policy, a new position responsible for leading the
Department’s multidisciplinary response to the opioid crisis, one of my top four priorities
as Secretary. It is appropriate that Admiral Giroir also
serves as the Assistant Secretary for Health at HHS. He understands that our pain management efforts
must be focused not only on preventing addiction, but also promoting healthy approaches to treating
pain. The need for balance in this work is also
well understood by Dr. Singh, our Chief Medical Officer in OASH, and a true expert on pain
management. I’ll now hand things back over to her. I wish you all the very best for this week’s
meeting, and in the work you have in the months to come thank you so much for your dedication
with these efforts. And thank you for your service to the American
people through the work on this task force. Thank you.

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