To the Editor In an editorial lamenting the US opioid epidemic, Madras1 focuses on the following solutions: implementing opioid guidelines, screening patients for substance use disorders, and training physicians on naloxone use. There is some evidence that opioid guidelines have slowed the growth of prescription opioid–related deaths: US Centers for Disease Control and Prevention data indicate that, since about 2010, deaths from “commonly prescribed opioids” have stagnated.2 This is likely due to policy changes that reduced both the demand for and the prescribed supply of opioids: in 2009, the Joint Commission dropped the requirement for documenting a “fifth vital sign” (made mandatory in 2000, just before the surge in opioid-related deaths began) and the American Pain Society (originally an advocate for the fifth vital sign) published opioid prescribing guidelines for chronic pain.3
Weeks WB, Goertz CM. Ineffective Policies to Address the Opioid Epidemic. JAMA Psychiatry. 2017;74(9):974. doi:10.1001/jamapsychiatry.2017.2216
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