Evidence-based medicine is how we connect research to clinical practice. It started in the 80s and 90s as of way of looking at how studies are done and how they could be applied to clinical care, and it’s gone through a number of changes over the years. Evidence-based medicine now is being applied to thousands of different conditions, and now I think it’s important to consider and assess is it accurate? Is it being used correctly? Are people or groups or stakeholders using it inappropriately in some cases? I think primary care should know that evidence-based medicine is very complex and many times the term gets thrown around and so they need to understand the basic components of it so they can judge clinical studies or guidelines when they come out and have an understanding of whether there was bias involved, how were the studies done, which studies did they look at. The goal for the practitioner should be to become a better user of clinical and research information.
The CDC guidelines for opioid prescribing were definitely an example of evidence-based medicine although they were done by a governmental body versus the usual practice where evidence-based medicine guidelines are written by scientific groups or associations. The CDC has a different mission, and the mission is to help protect the public. Really, the CDC guidelines were primarily done to decrease opioid abuse and heroin overdoses and misuse of medications. So there’s been some trepidation from some of the physician and provider groups that some of the recommendations may have not been evidence-based medicine, but more opinion or contextual support. I think in general the 12 recommendations are useful for physicians and providers in matters of patient assessment and monitoring, and in treating patients who develop other problems related to opioid use. But some of the evidence that they used was very low grade, and there’s a problem when the evidence is very low and recommendations are made. And if they just create fear for prescribers, if they’re misused or misinterpreted, then patients could be stigmatized and denied care that they could benefit from.