Speak Out Rheum: How Did We Go So Wrong with Opioid Prescribing?

Lessons Learned

I do not claim to have the answer to this conundrum, but all physicians can learn very important lessons from this experience. We need to be cautious about adopting therapies that make sense because, in the fullness of time, we may recognize that such a decision was misguided. And we need to be humble in judging previous practices made in good faith by physicians who thought they were doing the right thing for their patients.

I have been in medicine long enough to see the error of such ideas as “don’t start treatment of rheumatoid arthritis until it has been present for at least a year, because it might go away, and the treatments are very toxic.” In many cases, what we consider standard of care in 2022 may be regarded with derision decades later.

Richard Brasington Jr., MD, FACP, MACR, is emeritus professor of medicine at Washington University School of Medicine, St. Louis, where he was director of the Rheumatology Fellowship Program for 23 years. He is now a part-time community rheumatologist in Creve Coeur, Mo., and Chester, Ill. He is a Master of the ACR, and was elected to the Alpha Omega Alpha Honor Medical Society and the Gold Humanism Honor Society. He served as an associate editor of The Rheumatologist from 2012–17.

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