Table 3.

Examples of areas of disagreement in the Rules Document and revisions

Round	Examples of disagreement	Guideline author's reasoning	Revisions made in response
Round one	Strict discontinuation messages based on substance abuse or psychiatric diagnosis	Need to evaluate current status of diagnosis	Updated algorithm to generate all therapeutic options with contraindications for provider to consider and apply based on clinical judgement
Round one	Warning for patients that live >200 miles from VA.	Patients may have continuity of care even if living far away.	Recommendation to not provide opioid therapy and refer patient for care with a local provider was removed
Round two	Dose recommendation for short acting opioids combined with NSAIDs/acetaminophen	Concern about dose of NSAIDs/acetaminophen with medication combinations	Wording of message updated
Round two	Warning about patients with personality disorder	Warn specifically about anti-social and borderline personality disorders	Restricted warnings to persons with these specific personality disorder diagnoses.