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Comment & Response
September 2017

Ineffective Policies to Address the Opioid Epidemic—Reply

Author Affiliations
  • 1Department of Psychiatry, Harvard Medical School, McLean Hospital, Belmont, Massachusetts
JAMA Psychiatry. 2017;74(9):974-975. doi:10.1001/jamapsychiatry.2017.1668

In Reply My editorial published in JAMA Psychiatry1 elicited a thoughtful response from Weeks and Goertz. Notwithstanding the need for multidimensional solutions to the opioid crisis, the authors add to a compendium of proposals to reduce opioid prescriptions. They highlight the Low Back Pain Clinical Practice Guidelines issued by the American College of Physicians, which endorses alternatives to opioids for treating this common manifestation of pain. Analogously, the US Centers for Disease Control and Prevention issued a generalized set of practice guidelines and evidence-based alternatives to reduce opioid prescribing for chronic pain.2 Others have excavated prescribing practices by dentists and emergency department physicians to identify immoderate opioid prescriptions and recommend more rationally based prescribing practices.3 Some states have even set firm limits on the maximum number of prescribed opioids at initial encounters, irrespective of pain condition. A more rational approach is to develop detailed and specific guidance for clinicians treating specific manifestations of pain. With modern pharmacoepidemiological techniques capable of interrogating vast prescribing databases,3 it is feasible to identify current patterns of opioid prescribing for specific conditions, recommend changes in practice patterns, and create active programs to educate practitioners on these recommendations.4 Restraints on opioid prescribing practices have initiated a gradual deceleration in prescription opioids, but inadequate consideration of unintended consequences may have contributed to the transition from misusing medications to heroin/fentanyl use.1

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