Earlier this year, AAOS Council on Advocacy member John J. McGraw, MD, was appointed to a 30-member Pain Management Best Practices Inter-Agency Task Force overseen by the Department of Health and Human Services (HHS). As the only surgeon on the task force, Dr. McGraw joins a diverse group of federal representatives and nonfederal individuals—from agency employees to medical professionals to patients to members of the addiction treatment community.

The task force was authorized by section 101 of the Comprehensive Addiction and Recovery Act of 2016 and is led by the Department of Veterans Affairs and the Department of Defense, in addition to HHS. It was established to propose updates to best practices for pain management (including chronic and acute pain) developed or adopted by federal agencies, as well as to issue recommendations to address identified gaps or inconsistencies.

“It is a great honor to serve on the Pain Management Task Force,” said Dr. McGraw, who received nominations from Rep. Phil Roe (R-Tenn.), Rep. John J. Duncan Jr. (R-Tenn.), and AAOS. “As the only surgeon, I have a huge responsibility to represent acute pain and the orthopaedic community as we work together to combat this growing issue.”

Although orthopaedic surgeons make up only a small part of the total physician force, they write 5.8 percent of narcotic prescriptions. “Our surgeries are painful, and we have a tendency to prescribe and overprescribe narcotics,” he said.

Dr. McGraw has practiced in both the private and public sectors—having served in the Air Force and Army for a combined 34 years of commissioned service. During his tenure, he served three combat deployments, with the latest being in Afghanistan from 2011 to 2012. He has received multiple military honors, including the Meritorious Service Award.

Dr. McGraw’s military service and more than 30 years of private practice make him uniquely qualified to sit on the task force. His experience in local politics and AAOS advocacy efforts also equip him to better understand the legislative challenges facing Congress.

“I think it gives me the credibility I need to meet with members of Congress and advocate for issues affecting our specialty,” he said. “Most members are not healthcare experts, and they look to us to offer our perspective.”

Members of the task force met on May 30 at the opening session. From left to right: John V. Prunskis, MD; Linda J. Porter, PhD; Mary W. Meagher, PhD; John J. McGraw, MD; and Michael J. Lynch, MDCourtesy of the Department of Health and Human Services

Opioid crisis hits close to home

Dr. McGraw currently serves as medical director of OrthoTennessee in eastern Tennessee, where the opioid epidemic is one of the worst in the country. He is wrapping up a four-year term as Jefferson County commissioner and chairs the Jefferson County Board of Health, where he has worked with local law enforcement on the area-wide epidemic.

“It has financially devastated our county and region,” said Dr. McGraw. “Our jails are full, our courts are full, and more people are dying each year as a result of dangerous pain management.”

To help mitigate the problem, his 100-provider practice has implemented a process of e-prescribing controlled drugs, limiting the number of prescriptions, and allowing fewer doses per prescription. It also diligently provides patient education programs and collects informed consent for narcotics.

“We try to engage our patients so they have the decision-making power, but it is the surgeon who is responsible for educating them about the risks, options, alternatives, and complications associated with the drug,” Dr. McGraw said.

John J. McGraw, MD

An eye-opening experience

Although the epidemic has only recently become a public health crisis, Dr. McGraw said many physicians saw it coming for years. He explained that the push to recognize pain as the fifth vital sign, marketing messages claiming low addiction potential, and emphasis by government agencies to more actively control pain created the “perfect storm.”

He realized that physicians were overprescribing narcotics while on a deployment to Kosovo in 2009 as a colonel in the Army. American forces relied on narcotics for treating patients, whereas NATO allies used nonopioid alternatives, such as acetaminophen and naproxen.

“We had different thoughts on how to treat patients after surgery,” said Dr. McGraw. “It was an eye-opening time for us, seeing that we were prescribing so much more than the rest of Western world.”

Next steps

The task force will rely on the group’s knowledge and experience to help defeat America’s crisis of opioid addiction. It held its first meeting in May and will meet publicly at least twice per year. Subcommittees, which deal with matters within their respective areas of expertise, may meet more frequently. Dr. McGraw is a part of the Subcommittee on Acute Pain Management, Physical Therapy (PT), and Interventional Minimally Invasive Methods.

Within one year after it convenes, the task force must submit proposed updates and recommendations to relevant federal agencies and give the public at least 90 days to comment. Then it will develop a strategy for disseminating information to stakeholders. Dr. McGraw said he hopes Congress will recognize the work the group is putting into this responsibility and take note as it tries to implement the recommendations.

One recommendation that Dr. McGraw said he personally feels strongly about is using a multimodal approach for pain management. “Narcotics are not the only solution and may not even be the best treatment for certain pain conditions. PT, acupuncture, nonopioid medications, regional blocks, and even mindfulness are sometimes helpful,” he said.

It’s clear there are gaps within existing pain management policies that need clarification and additional research, and Dr. McGraw said he is convinced that the task force’s final product will reflect much-needed best practices.

Disclosure: Dr. McGraw also serves as a member of the AAOS Now Editorial Board.

Kristen Coultas is the communications manager in the AAOS Office of Government Relations.