It will be hard, if not impossible, to shut down the supply, but we have to try.

On the demand side, we can do things to try to prevent addiction. But the new Medicare guidelines, which cover disabled individuals and those 65 and older, would only make things worse.

They would deny coverage to any patient taking more than 90 milligrams of morphine or the pharmacologic equivalent daily for more than seven days, except for those with cancer or in hospice (an exemption from this guideline is possible but burdensome). The Centers for Medicare and Medicaid Services estimate that some 1.6 million Medicare beneficiaries are prescribed opioids that meet or exceed this arbitrary threshold, so the change, if it goes into effect as planned next January, will suddenly put a very large number of people at risk of severe opioid withdrawal and the return of pain and suffering. This could well drive many of them to synthetic opioids.

Instead, we need a rational drug policy both to rein in the excessive prescribing of opioids and to help the people who are already dependent on them.

First, we need a national prescription database. The state-level databases that we have now are not enough. They allow clinicians to identify patients who “doctor shop” and are high consumers of opioids, but patients can still fill their prescriptions in nearby states, and no one is the wiser.

We also have to deal with doctors who contribute to the epidemic. The Drug Enforcement Administration, using that national prescription database, should identify clinicians, particularly those who aren’t pain specialists, who are outliers in their opioid prescribing patterns, review their treatments and clamp down on inappropriate and excessive prescribing.

This is tricky; we do not want to discourage doctors from adequately treating pain out of fear of legal sanction. But those who adhere to current standards of care should have little to fear.