Opioids are not the only way to manage pain. There are many non-medication approaches, ranging from high tech to over-the-counter. But physicians say they don't have sufficient access to alternatives or lack the training and leadership needed to change their prescribing practice. Use of non-opioid options increases when there is broad system support promoting it.

There is little evidence that practice guidelines alone can effectively promote appropriate pain management. Integrating guidelines with ready access to non-opioid pain medications and educating providers about how to use alternative therapies could make guidelines more effective.

Prescription drug monitoring programs are state-specific databases that track the prescribing and dispensing of controlled prescription medications. All 50 states have such programs, but they differ across states. States with more complete and timely opioid monitoring have greater reductions in overdoses.

Overprescribing is widely viewed as a major reason for the continuous rise in opioid mortality through 2010. Studies suggest that as many as 40% of treatment episodes involve at least one measure of high-risk prescribing: prescribing a higher dose than medically appropriate. Such prescribing is concentrated among a relatively small group of physicians.