In Reply I agree with Drs Chhabra and Leikin that The Joint Commission should have examined ways to address the opioid epidemic earlier, and the organization should learn from this experience. Past criticism of the pain standards may have caused some reluctance to tackle the emerging opioid epidemic.
Their letter incorrectly states there was no “clamor” for standards. After several national and international guidelines failed to improve the severe undertreatment of pain that was prevalent at the time and numerous articles showed persistence of the problem, Max1 wrote in 1990 that education was not enough and recommended a different and more aggressive approach. Even the US Congress joined the call, passing a bill in 2000 that established the “Decade of Pain Control and Research.”2 The Joint Commission’s pain standards were developed with funding from the Robert Wood Johnson Foundation (the only organization that provided funding), which shows that this philanthropic organization saw the standards as a way to address a public health priority.