A recent editorial in the prestigious New England Medical Journal has highlighted a phenomenon whereby a lack of cautious discretion, or even a misapplication of guidance can result in adverse consequences for patients. Referencing the relatively recent CDC guideline for prescribing opioids for chronic pain, the authors cite examples including:

  • inflexible application of recommended dosage & duration thresholds
  • policies that encourage hard limits & abrupt tapering, sudden opioid discontinuation or dismissal of patients from a prescriber’s practice.
  • misapplication of the recommendations to populations outside the scope of the guideline (e.g. patients with cancer pain)
  • misapplication of dosage thresholds to opioid agonists for treatment of opioid use disorder

The editorialists call for the sensible and sensitive application of the guidelines in the interests of patient care. There are a lot of situations where this type of scenario exists, and clinicians would be well-advised to consider the implications of the blanket implementation of rules-based decision making that can arise from the indiscriminate application of treatment guidelines.