OCTOBER - 20209The opioid epidemic prompted the CDC and other legislative entities to place recommendations and regulations around opioid prescribing and monitoring. Much of the regulations center around monitoring the types of controlled substances, the dose, and the prescribing patterns of the practitioners to avoid multiple prescribers for controlled substances. More specifically, they recommended having a pain agreement to discuss the risks of being on opioid medication and other controlled substances, monitoring patient's control substance prescription filling patterns on electronic data-base, and keeping the morphine equivalent daily dose (MEDD) below a recommended level as priorities of numerous health systems. The EPIC electronic medical record system, which is used by a number of medical systems and Universities, has developed some convenient tools to help practitioners and medical leadership to monitor and track opioid prescription. The features enabled administrators of health systems to learn what their practitioner's opioid prescribing data are and if there are any outliers. Many health systems were able to establish policies or recommendations based on the data they collected from the electronic medical records (EMR). Numerous large medical systems have done this and even went as far as using MEDDs of their patients on opioids to be goals for their institutions. Although on the surface it may look like these initiatives were set to ensure quality and safety in their patient care. However, there are potentially very serious unintended consequences with this approach. Additional editorials have been released by the CDC cautioning against this potential consequence. What many states observed was that these patients get abandoned due to their MEDD or placed on a weaning schedule that they cannot adhere to achieve institutional goals and adhere to guidelines or policies. This can result in the patients having decline in their function and quality of life or worse, end up using street medications and having increased adverse events or costing their lives. The purpose of this article is to acknowledge the advancement in EMR systems by providing medical systems and practitioners with tools to better monitor and risk assess their patients in their opioid use and ultimately to lower their risk of death due to opioids. However, acquiring the data can at times have the opposite affect if practitioners and health systems grow fearful of this patient population and end up dismissing them due to the risks and liability. This in turn can end up making our efforts to save these patients to become counterproductive. This commentary, I feel follows the same lines as the most recent governmental corrective recommendations on their initial letter of recommendations surrounding the opioid epidemic. As we swing from the pendulum of medicine and public policies, real medicine seems to reside somewhere in the middle, centering around the patient. The opioid epidemic prompted the CDC and other legislative entities to place recommendations and regulations around opioid prescribing and monitoring
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