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Prescription Opioid Tapering & The Harms Of Withdrawal.

opioid pain medications
The guidance is the first from NICE to specifically cover medicines that can cause dependence or withdrawal symptoms

In the United Kingdom ‘The National Institute for Health and Clinical Excellence (NICE) has not taken into account the experience of thousands of patients in the advice it gives on tapering the dose when discontinuing certain medicines, according to a group of parliamentarians.

In its response to the publication of NICE guidance on how to manage the withdrawal of medicines, such as opioids, benzodiazepines and antidepressants, the All-Party Parliamentary Group (APPG) for Prescribed Drug Dependence says the institute “fails to listen to patient evidence.”

AND the APPG statement also says: “guidelines fail to provide simple instructions for slow tapering, which is the most important intervention for safe withdrawal. Currently, many patients report being taken off their drugs too quickly, which can lead to devastating and long-lasting withdrawal symptoms.”

It seems America, the United Kingdom & Australia have ALL decided to embark on the “deprescribing” prescription opioids bandwagon, even though the vast majority of chronic pain patients do NOT suffer from addiction AND use their painkillers as prescribed. It is well-known now that most substance abuse behaviours are NOT due to chemical addiction or “just one use of an addictive pain pill”, but rather due to environmental/genetic factors, including childhood trauma etc. The American “opioid crisis” is worsening, however, this is largely due to Non-Prescription, Non-Medical use of opioids, i.e. illicit Fentanyl analogues.

It is also a fact, that deprescribing or rapidly tapering prescription opioids off chronic pain patients, who have been using them safely and responsibly for many years, only leads to extremely harmful or negative outcomes. For example, in a large American Retrospective Study with a total cohort of 113,618 patients, it was noted in the Conclusion: “Among patients prescribed stable, long-term, higher-dose opioid therapy, tapering events were SIGNIFICANTLY associated with increased risk of overdose and mental health crisis.”

While treating chronic non-cancer pain with opioids is not without risk, some patients for whom all other therapies have failed can be SAFELY and effectively treated in this way. These patients experience reduced pain and IMPROVED quality of life. Surely opioids must not be denied to those who benefit the most? ALL International Guidelines should reflect more inclusive policies, not an inflexible and “non-negotiable” one-size-fits-all approach!!

IN SUMMARY, why are chronic pain patients around the world being punished for a misunderstood “opioid crisis” they did not create? The opioid crisis is not about opioids, it is about addiction & mental health & societal despair. The majority of drug overdose deaths in Australia are due to multiple substances, not just opioids ALONE, so perhaps the real crisis we are facing worldwide is a “substance abuse” problem, not an opioid abuse problem?

Kevin R James
Author: Kevin R James

Chronic Pan Patient Advocate and Writer. Medically Retired RN [B.Nurs.]

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