In their latest attempt to curb the overprescription of opioids, Florida legislators added some new rules to a statute on what health care providers must say before prescribing, ordering, dispensing or administering opioids, regardless of any history of addiction or misuse. Unfortunately, those rules require providers to hand out a pamphlet of “alternatives to opioids” that have little to no basis in actual, evidence-based medicine; at any rate, none of them are going to replace opioids.

The pamphlet comes from the state Department of Health, and includes helpful suggestions like “self-care” (read: using cold and heat), and, more problematically, chiropractic and massage therapy. As pointed out by Science Based Medicine, neither of these treatment options were included in the original draft of the proposed rules, but were added later. (Neither of these things are endorsed as alternatives to opioids in the CDC guidelines, which suggest things like NSAIDs, acetaminophen, or antidepressants, possibly used in combination with each other or other treatments.)

The wildest thing about the new rules is that they make no exception for patients with terminal conditions, cancer pain, palliative care or certain traumatic injuries. This means both a person with a sprained ankle and a person with terminal cancer will be given a pamphlet that kindly suggests a massage in lieu of prescription painkillers, or perhaps a nice spinal adjustment from a chiropractor.