“It does identify an association . . . and provides some evidence that the guidelines may have contributed to a larger decrease in numbers of prescriptions,” he observed. “However, the study (could not) determine whether any of the prescriptions that were written actually followed the guidelines, and there is no way to know whether individual prescriptions were given for appropriate medical indications either before or after the guidelines were developed.”

Although the guidelines “can help guide medical providers while still permitting appropriate medical decisions to be based on each individual patient encounter,” he added, “guidelines that focus on only one medical specialty . . . have a limited ability to have a significant impact on the larger public health issues regarding opioid use in our country. We need to continue looking for opportunities across all medical specialties for ways in which we can use these medications responsibly,” Dr. Fitch concluded.

Dr. Stephen Thornton, medical director at the University of Kansas Health System Poison Control Center in Kansas City, agree that the study can only show correlation, not causation. Decreases in prescriptions “might be due to the state guidelines or due to the national pushback against indiscriminate opioid use,” he told Reuters Health.

“Either way,” he said, “it is another piece of evidence that the tide may be turning against the opioid epidemic. There are clearly times when prescribing an opioid is appropriate but it should not be a first-line agent,” he added.