When the Best of Intentions Leads to Bad Outcomes

Abstract

There is no question that the opioid use problem in America has reached unacceptable proportions. What is in question, however, is the best way to address this problem. Unfortunately, this is a multidimensional problem that will not be solved with a simple unidimensional solution. This commentary examines the multidimensional nature of this problem and the resultant guidelines that have been proposed to address it. There is a cautionary tale of the historical dangers of applying an "obvious" solution to a problem, only to find that more investigation and an iterative approach can actually lead to the correct solution. In particular, the authors question the wisdom of implementing guidelines that have no provisions for re-examination, to assess both intended as well as unintended consequences that might occur. This is the standard for good evidence-based guideline development and implementation. To do less, even under such dire circumstances as these, is to provide less than optimum medical care.

Keywords: Guideline development; Illicit opioids; Opioid use disorder; Prescription drug problem.