Punishing Pain: Why Treating Chronic Pain with Opioids Needs a New Standard of Care

Abstract

Chronic pain, opioids, and the overdose crises have a fraught relationship. Without effective pain treatment, patients face significant harm. Opioid dose reductions or total cut-offs threaten the safety of patients who already take opioids without issue, particularly those who have a history of doing well on a high dose for a long time.

To combat the overdose crisis, law and policy actors zeroed in on those closest to prescription opioids—prescribers and chronic pain patients. Guidance from public health organizations, like the Centers for Disease Control and Prevention (CDC), recommended restrictions on the number of opioids physicians should prescribe and how long patients could take them. One of the more significant initiatives to limit opioid prescribing came in 2016 when the CDC released its first Guideline for Prescribing Opioids for Chronic Pain (“CDC Guideline” or “Guideline”).

The Guideline prompted physicians to taper patients to lower doses or suspend opioid treatment altogether. Nothing about the Guideline itself compelled physicians to follow it. Nevertheless, individual states and regulatory bodies enshrined it in law. The CDC Guideline shaped the medical profession to favor limits and restrictions on using opioids for treating chronic pain and how courts and legislative bodies enforce this standard as law.

The problem: the CDC Guideline is an unreliable source for the standard of care that effectively shields liability for physicians who follow the Guideline, even when doing so causes patient harm.

Fixing the standard of care requires a diligent effort by the CDC and state legislatures, and the solution can address both untreated pain and opioid misuse, thus preventing further harm to Americans suffering from chronic pain, opioid use disorder, or on the brink of overdose.

Note:

Funding Information: I did not receive any funding from any organization to write this article.

Conflict of Interests: I have no conflicts of interest to declare.

Keywords: opioids, chronic pain, medical malpractice, prescribing, CDC, health policy, guidelines, opioid crisis, overdose, standard of care, law

JEL Classification: K32, K13, I18