The updated guideline contains beneficial changes. Among them, certain prescription duration limits and the upper MME dosage threshold have been removed. There is some acknowledgment that pain treatment is indeed important. Yet, the inappropriate usage of the 2016 guideline and policies created in its image to harass, prosecute and even jail clinicians must be specifically and adequately addressed. The MME threshold now in the revised version is no more scientifically sound than the ones in the previous version, and it has already been shown that dosage levels are too easily interpreted with rigidity by policymakers and payors. Until these issues are resolved, the fallout has the potential to harm patient care into the future.