In  kindergarten, most of us learned that "two wrongs don't make a right." By trumpeting the current problems with opioid overuse as "One of the great mistakes in medical history" (Opinion Exchange, April 17), John Paul Scott is in danger of aiding and abetting a violation of that principle.

When I trained as a physician in the 1970s, we were taught that opioids were the most potent pain medications available but that they also were addictive and dangerous in overdose. This has been known for generations, and there is no new science that substantially alters those facts.

Twenty years ago, some clinicians identified what they thought represented an underappreciation and undertreatment of pain on the part of many physicians, and they called for improvement. Unfortunately, this reasonable initiative got hijacked by crusaders and zealots, who cited ostensibly scientific evidence to support the view that pain required immediate and total eradication and that opioids were the solution. The potential for abuse and addiction, we were told, was exaggerated or unimportant.

Drug companies and pain clinics were all too pleased with this view. Eventually, these combined forces gained the ears of legislators and regulatory bodies and, in time, their views were enshrined virtually as law. This is medical care by mandate. Physicians who — on the basis of simple pharmacology and clinical experience — questioned this approach were accused of ignorance and insensitivity to patient needs. An entire generation of physicians now has been trained to think of chronic opioid treatment as normal.

We are now reaping some of the predictable effects of these policies and practices. The costs — a flood of opioids into the drug-abuse market and millions of medically addicted patients — are now undeniable.

While this phenomenon desperately needs to be understood and corrected, the process is in danger of being controlled by a new generation of crusaders and zealots. Now we are being told — based once again on a highly questionable interpretation of science and data — that opioids are not effective for chronic pain and that the millions of individuals addicted to opioids can simply stop their medications and treat their pain with acupuncture. As before, this view is endorsed by interested parties, such as the drug-treatment specialist quoted in Scott's article whose national network of drug-treatment facilities would stand to benefit from millions of individuals needing help to wean themselves off opioids.

Statistics from the Centers for Disease Control and Prevention — which do not distinguish between medical and nonmedical use of opioids or between real and counterfeit "prescription" drugs — are cited uncritically in support of the notion that the medical use of opioids leads directly to heroin use and overdose.

Just as we were told in the past that addiction was imaginary or irrelevant, now we are being told that the incidence and severity of opioid withdrawal is minimal. And as for the patients who really might need and benefit from opioids, few of the voices calling for a Draconian crackdown on opioids seem to have much of a plan for the ongoing management of these individuals.

Thoughtful physicians failed to stop the "give everyone opioids" juggernaut, but it's not too late to stop the "give no one opioids" crusade. Certainly, we need to ramp down the overuse of opioids. Patients who can do without them should be provided with good alternatives, supervised withdrawal and ongoing support. But we also need to tune out the extremists and tone down the rhetoric, and avoid terms like "epidemic" and "worst medical mistake in history."

Hype, uncritical thinking and a bandwagon mentality is what got us into this situation. Should we trust a similar process to get us out?

Pain is perhaps the most common of human medical problems, and we physicians cannot abdicate our duty to treat it. In each patient encounter, we should be making medical decisions based on the perceived benefit to our patient — not based on external pressures and trends. In the long term, we should educate, train and empower physicians (starting in medical school) to make cautious, humane and defensible judgments about the use of opioids — type, dose and duration — in each individual patient.

Todd Grant, of Golden Valley, is a retired physician.