We write to register our opposition to this binary high-stakes metric on three distinct grounds. They are as follows: 1. Reliance on a simple binary dose metric is an extremely poor method to identify persons at-risk for adverse events while receiving opioids, as it is both extremely insensitive and non-specific. 2. A high stakes binary dose metric of this nature incentivizes medical practices that are not based on evidence and that have proven dangerous, both in our observation and in the emerging literature on opioid dose reduction. 3. High stakes binary numeric metrics for care quality have a robust history of incentivizing harmful medical practices. Tragic outcomes are even more likely in the context of parallel initiatives from governmental and non-governmental agencies mandating or incentivizing opioid dose reduction without reference to patient safety.