The United States is facing twin epidemics of pain and opioid misuse. Both are challenging, multifaceted problems with numerous comorbidities, treatment gaps, stigma, and increased risk of death. The role of prescription opioids in soaring rates of drug overdose and death has drawn considerable policy attention at the federal and state levels. While the focus on limiting the flow of medications is understandable, it may, intentionally or not, hinder access for patients who rely on opioids as a component of managing chronic or end-of-life pain.

This issue brief outlines the ways in which some of the key policy responses to the opioid epidemic – prescription drug monitoring programs, heightened DEA enforcement, “lock-in” programs, prescriber restrictions, and even guidelines – could affect patients in pain. Important as these policies may be, very limited attention has been paid to minimizing collateral harm to people living with or dying in pain. Additional oversight and monitoring is crucial to ensure that individuals in pain are not harmed by the unintended consequences of various policy responses.

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