Oh look something like this again.
The most rational way forward is to acknowledge:
1) As there is no compelling data showing long-term benefit from COT for non-cancer MSK pain, initiation should be a rare event.
2) Refugees on high-moderate mme are at increased risk of suicide if they’re abruptly cut off.
3) Nobody really knows what do. A think tank of pain physicians, addiction docs, pcps, DEA, FDA, national elected leaders would probably have the best chance of coming up with a true system-wide change for opioid prescribing, monitoring, etc. This won’t happen.
4) At a minimum, unless the government grants some sort of modified sovereign immunity for docs who take on refugees (and pays them fairly for doing so), most of these patients will continue to wander in the desert.