John J. McGraw, MD

AAOS Now

Published 8/1/2019
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John J. McGraw, MD, FAAOS, COL (retired), U.S. Army Medical Corps

A Federal Task Force: Another Way to Serve My Country

On May 30, 2018, along with 12 other healthcare experts on pain management, I raised my right hand to defend the Constitution and become a Special Government Employee as part of the Department of Health and Human Services’ Pain Management Best Practices Inter-agency Task Force. The designation provides no salary; however, travel expenses and per diem are reimbursed.

I had raised my hand three times before. In medical school, I joined the U.S. Air Force and served first as an active-duty officer, then in the Air National Guard, and last in the Air Force Reserves. After Sept. 11, 2001, a wave of patriotism found me donning an Army uniform and serving two more military deployments. I turned 61 years old during my final overseas mission to Afghanistan. My third oath of office was recited in the Jefferson County Courthouse in Tennessee when I was sworn in as a County Commissioner.

So why would I volunteer for another government position, this one without compensation? President Barack Obama and Congress realized that the opioid crisis was escalating, and the Comprehensive Addiction and Recovery Act was signed into law in July 2016. A major provision of that law required that pain management experts from a variety of backgrounds come together and provide insights into the severe problems facing many communities across the nation, like my hometown in Jefferson County, Tenn.

Even before convening a panel on Opioids and the Practice of Orthopaedic Surgery at the 2014 AAOS Fall Meeting in Nashville, Tenn., I watched my community and orthopaedic group wrestle with the problems of this epidemic. It was consuming a large portion of our county budget due to the increasing need for law enforcement, emergency medical services, and jails. Our rural hospital had to ramp up resources to handle overdoses and cases of withdrawal. Our court system wisely started a “drug court” to confront a different type of crime. All of this strained resources and personnel who were trying to get a handle on the situation.

For me, being appointed to the Pain Management Best Practices Inter-agency Task Force was an opportunity to serve my community, my profession of orthopaedic surgery, and my country.

I received nominations from the two Congressmen representing Jefferson County: Representatives Phil Roe and John J. Duncan Jr. AAOS also sought volunteers through the Committee Appointment Program system. In all, the task force had 29 members, including eight federal employees representing agencies such as the Food and Drug Administration, Drug Enforcement Agency, Centers for Disease Control and Prevention, Department of Defense, Department of Veterans Affairs, and more. Many large research centers such as the Mayo Clinic, Cleveland Clinic, and Stanford University also were represented. Other people from private practice and smaller communities severely affected by the opioid epidemic had seats on the task force, which was chaired by Vanila Singh, MD, MACM. Her outstanding leadership and commitment to the mission and our final report cannot be overemphasized.

In total, we had three meetings in Washington, D.C., and almost weekly two-hour conference calls. When we divided into three subcommittees, our work seemed insurmountable. Week by week, however, we gradually read through a mountain of articles and research papers in an attempt to ensure an evidence-based final report (the final report contains almost 500 references).

One very real aspect of the year-long effort was that, despite somewhat frequent disagreements and a few heated arguments, we all became friends—some of us close friends. We were drawn together by a lofty goal and learned to respect the cause for unity in spite of diversity.

One other reason why I was selected to the task force was because of my role as medical director of OrthoTennessee, the largest orthopaedic clinic in the Volunteer State, with more than 100 musculoskeletal practitioners. Our location in a relatively poor region of Appalachia is significantly affected by the opioid epidemic, and this gave me unique challenges in education and the changing of prescribing habits. I had tremendous support from CEO Jon-David Deeson and Board Chair Robert Ivy, MD. With what I learned as a task force participant, I have been able to guide our group toward a more multimodal approach to pain management.

At the foundation of the year-long effort was my affirmation to represent the AAOS vision of pain management and use of opioids. In fact, I introduced the task force to our Pain Relief Toolkit, which had already given guidance to our individual practices. Our belief was that the fewest pills, at the lowest dose, for the shortest duration was the “gold standard” when prescribing opioids for our patients with acute pain. Those concepts are firmly embedded in the final report.

The draft report was published on Dec. 30, 2018. It received more than 6,000 public comments, including two from AAOS. The final report received only one dissenting task force vote and was sent to Congress on May 30—exactly one year after the task force was assembled.

Although the effort was time consuming and laborious, I’d gladly do it again. Now, I can only hope that Congress will use the report to help solve these problems facing our nation as medical communities work toward controlling the acute and chronic pain of our patients.

John J. McGraw, MD, FAAOS, is an emeritus AAOS member and medical director of OrthoTennessee. He previously served on the AAOS Board of Councilors, Board of Directors, and AAOS Now Editorial Board.