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Balancing the Risks and Benefits of Opioid Therapy for Patients with Chronic Nonmalignant Pain: Have We Gone Too Far or Not Far Enough?

In this issue of Pain Medicine, the article “Are Prescription Opioids Driving the Opioid Crisis? Assumptions vs Facts,” by Mr. Rose [1], raises some interesting questions and apprehensions concerning the current policy on prescribing opioids for patients with chronic nonmalignant pain (CNMP). In his article, Mr. Rose challenges the validity of the data that have been employed to support the recommendations of current opioid prescribing guidelines and, in general, the wellpublicized and politically charged trepidations regarding a national “opioid epidemic.” His main conclusion was to challenge the underlying assumptions about opioid analgesics with respect to lethality and efficacy. In his concluding remarks, he states, “Illicit fentanyl and heroin, not opioid prescribing, now fuel the current opioid overdose epidemic.” He goes on further to say that this collective fear of a burgeoning opioid epidemic has “potentially devastating effects on uncontrolled chronic pain” and that legitimate pain patients who might benefit from opioid therapy cannot gain access due to this new guiding philosophy and adopted standard of care. In response to Mr. Rose’s manuscript, Dr. Mark Sullivan [2] thoughtfully addressed the major tenants of Mr. Rose’s arguments on the importance of more liberal access to opioid therapy for patients with CNMP and countered many of his opinions on the prevailing data that have guided the current state and national decision-making around opioid analgesic therapy.