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Comment & Response
August 16, 2016

Prescribing Opioids for Chronic Pain

Author Affiliations
  • 1Baltimore City Health Department, Baltimore, Maryland
  • 2Vanderbilt University School of Medicine, Nashville, Tennessee
JAMA. 2016;316(7):774. doi:10.1001/jama.2016.9236

To the Editor The CDC’s new guidelines for prescribing opioids1 represent a milestone in addressing the opioid epidemic. They bring national attention to the prescribing practices that drive this crisis and offer concrete steps to correct the course. However, to truly end this epidemic, efforts must extend even further.

First, offering naloxone co-prescriptions to patients at risk of overdose is necessary but not sufficient. In Baltimore, best practice letters have been distributed calling on every physician to co-prescribe naloxone to any patient receiving opioids. Naloxone is present in acute care settings to reverse the effect of opioids—it should also be available in patients’ homes in case of overdose. Last year, the state of Maryland issued a blanket prescription for naloxone to the city so that Baltimore’s 620 000 residents can be equipped to respond to overdose situations.2 Given the well-established safety profile of naloxone, randomized clinical trials are not necessary to decide who should carry it.