Many efforts have been implemented to address the opioid epidemic, such as guidelines and targeted communications to prescribing clinicians. This commentary summarizes findings of an expert consensus panel exploring the impact of the Centers for Disease Control and Prevention opioid guideline, implementation challenges, and unanticipated effects. The panel generally supported the guideline and suggested tactics to avoid unintended consequences, including engaging patients directly in pain therapy changes and improving management of opioid use disorder.

High-risk opioid prescribing practices contribute to increased opioid use and opioid-related harm. In this cohort study, researchers found that potentially inappropriate opioid prescribing was associated with increased risk of all-cause mortality and both fatal and nonfatal overdose.

Nationally, opioid overdose remains a common cause of preventable death. Treatment of opioid use disorder with opioid replacement therapy, specifically methadone or buprenorphine, is a potent but underutilized strategy for reducing opioid-related harm. Investigators employed a prospective cohort study to follow 17,568 adults who were treated in Massachusetts emergency departments for a nonfatal opioid overdose. About 15% received opioid replacement therapy in the subsequent 2 years. Patients on opioid replacement therapy were substantially less likely to die from opioids or any other cause. An accompanying editorial from leaders at the National Institute on Drug Abuse highlights strategies to increase the number of Americans offered these life-saving therapies. The editorial also notes the alarming number of patients who received prescriptions for short-acting opioids and benzodiazepines after an opioid overdose. A past Annual Perspective and PSNet perspective delineated other strategies for addressing the opioid crisis.

This commentary recommends that health care providers and government agencies contribute to efforts to prevent opioid overdoses through strategies such as raising awareness, publicizing overdose education, and screening patients for overdose risk.

This study found that documentation of a patient's opioid dependence or participation in a methadone maintenance program was suboptimal and created opportunity for potentially unsafe medication interactions.