For more than a decade, members of relatively unknown group called the Pain Care Forum have berated Washington with messages about the necessary role prescription painkillers play in the lives of millions of Americans, helping to derail efforts to reduce U.S. consumption of opioids. The Pain Care Forum is a loose coalition of drugmakers, trade groups and dozens of nonprofits supported by industry funding. From 2006 through 2015, participants in the Pain Care Forum spent over $740 million lobbying in the nation’s capital and in all 50 statehouses on an array of issues, including keeping opioids accessible. When the FDA began developing plans to reduce the misuse of long-acting opioids, the Pain Care Forum intervened with a “strategy to inform the process,” according to an internal memo from the American Pain Foundation, which is no longer a member of the forum.

The FDA’s initial proposals included requiring doctors to undergo certification training to prescribe opioids and tracking opioid prescriptions via databases. In retaliation, the forum helped generate more than 2,000 comments against new barriers to opioids and a 4,000-signature petition opposing electronic registries, according to another pain foundation memo. Regardless, the final guidelines appeared in March. The first recommendation for U.S. doctors was unequivocal: “Opioids are not first-line therapy” for routine chronic pain. It was a statement considered common practice by many doctors as recently as the early 1990s, a decade before the Pain Care Forum formed in Washington.

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