Prescribing Guidelines: Where to go From Here?

The CDC guideline was a good idea, but the way that it was brought about, the procedure that was used, the people that were invited, the process itself, negatively impacted the end result. And that continues to create problems in the areas of misinterpretation, not only by policymakers, but also by physicians and other healthcare providers. What would be helpful for the CDC to do, of course, like any type of government entity regarding policy, is to evaluate it for its impact, both intended and unintended. And if corrective action is necessary, it should be taken. As well, we should highlight the problems associated with involuntary tapers, which are occurring across the United States, and also highlight the primary role that illicit opioids, such as heroin, are having on the overdose rate in the United States. The narrative that all opioids are bad is an easy narrative. Unfortunately, of course, the devil is in the details.

One solution to improve the CDC guideline is to ensure that all relevant stakeholders have a seat at the table and are able to provide input. Now, of course, not everyone will agree, but it’s important for everyone to be heard. Ten years from now, what we will probably find is another swing of the pendulum. What that pendulum would look like is difficult to predict, but the overarching concept really should be the reduction of unnecessary human suffering, so that we avoid the zero-sum game mentality of it’s either pain treatment or it’s preventing abuse. And so, if we’d go with this framework of the reduction of unnecessary human suffering, we would be concerned about those who are suffering from opioid use disorders; we would be concerned about those that are being not treated adequately for their pain; we would be concerned about options, alternatives that are safe, effective, and covered by insurance.