States have tried to respond to the opioid overdose epidemic, and one of the more recent innovations has been a focus on dosage thresholds and subsequent triggers. Once a chronic pain patient, for example, reaches 120 mg morphine equivalency per day, it triggers a particular action or recommendation. The concern about these models is that they’ve not been evaluated and that they are very much focused on this idea of preventing overdose, while at the same time there’s another huge epidemic, that of undertreated pain.
When it comes to science and politics oftentimes politics trumps science. So when we’re dealing with dosage threshold policies, instead of making mandatory rules, they should be at least advisory guidelines until these models can be evaluated for their efficacy and their impact on pain patients.