Patients need a medical home, Shames said. If physicians have a plan built around safety and continually assess the patient, "the board is unlikely to get you in trouble," he said. But even patients doing well with pain on high-dose opioids "are really not safe" from overdose, he said. They would do better on buprenorphine, he said, which can address pain and withdrawal symptoms but has a lower risk of misuse because it does not create the same level of euphoria and respiratory depression.