Concern over the national opioid epidemic has resulted in a crackdown on physician prescribing abilities. Many frontline physicians and clinical leaders feel caught in the middle — acknowledging the national crisis of opioid addiction and wanting to adhere to the new guidelines, but also wanting to decrease patients’ pain.

The quandary is illustrated in two federal policies issued in March 2016. The same week that the Centers for Disease Control and Prevention (CDC) launched a national opioid response, a federal advisory committee announced a National Pain Strategy declaring pain a “significant public health problem” and calling for a broad set of solutions. The opioid guidelines have received far more attention, however. Although the CDC’s limits on prescription duration and dosage were recommendations, many states turned them into laws that limit physicians’ ability to provide opioids for more than a few days. Some of the state laws allow flexibility in treating chronic pain patients, but not all. Meanwhile, health plans, pharmacy benefit managers (PBMs), and pharmacies have jumped in with their own restrictions.