Well, the State of Washington is leading the charge to reverse the opioid epidemic. I am right now at ground zero -- seems like about 1/3 of this "family medicine review" is about how we FP's have been inappropriately prescribing.
So now, 50 MED is the current magic number, down from 120 MED. (And down from no practical limit a few years ago.) Benzos are absolutely forbidden. And don't even mention Soma.
All long acting opioids are anathema now, and especially methadone is beyond the pale. The concept of continuous saturation of the opioid receptors with long-acting drugs and using short acting for "breakthrough" has been deemed bogus -- leaving us all with an overhang of many people addicted to long acting drugs.
Absolutely topsy-turvy from what we were taught 15 years ago -- and MADE TO PRESCRIBE!
But the drug companies, pain specialists, medical schools and in general, all the "experts" have denied responsibility for this - it now falls to the lowest on the totem pole (the "PCP") to get everyone off their drugs. Because we prescribe them, of course, and are therefore responsible. The "pain specialists" don't prescribe drugs -- it's beneath their pay grade. They just do procedures.
I'm just about ready to quit medicine, but first I'm just going to stop all opiates and let people suck it up. Of course, I will hear them out, and empathize -- "I do so feel your pain, but you must understand that the pain is not really in your body, but actually in your nervous system, and a product of inappropriate expectations and hyperalgesia caused by inappropriate prescribing".
Cognitive behavioral therapy is what you need.
