Spitballing, but maybe the problem is that no doctors wants to be the guy in town who's the most generous with opioid prescriptions, as then he'll get swamped by people seeking opioids?

People who look at the statistics after that, finding our doctor prescribing a significant amount of all opioids in the community, are liable to think that he's some sort of unscrupulous stooge of a pharmaceutical company.

That'd cause a race to the bottom of pain medication skepticism. To fix that you'd need some sort of liability reform (as just changing guidelines will never work if it's opposed to a self-sustaining incentive gradient), though I'm not sure what that would actually entail.