We warmly commend the three authors of the CDC Guideline for publishing a lead Perspective in today's New England Journal of Medicine, "No Shortcuts to Safer Opioid Prescribing". The authors make clear that the Guideline did not urge, and does not support policies and practices that mandate dose reduction or discontinuation, even though it does support individualized assessment of the potential value of tapering doses. Judiciously, Drs. Dowell, Hagerich and Chou write, "Policies should allow clinicians to account for each patient's unique circumstances. " Their article underscores the need for careful, individualized decisions, a value inherent in the original Guideline, and yet - as the authors note-- frequently not upheld in policies in practice. Their statement sets the table for a necessary revision to policies instituted across the country that utilize mandates, strong incentives and implied threats in ways that have been harmful to patients.
The Guideline authors' response has our admiration and support. It responds thoroughly and with the highest standards of medical practice to the concerns we raised to the CDC on March 6, 2019, with the support of 318 clinicians and 3 former United States Drug Czars.
