Published in Pain Medicine, Volume 20, Issue 3, March 2019
First published in 2018
Forced opioid tapering in the US was rampant and many high-profile pain management experts were concerned about the serious (and unjustified) harms, including overdose and suicide, that opioid tapering was causing. This is not so much a study, as a consortium of prominent pain medicine doctors, researchers, psychologists and psychiatrists stating their significant concerns regarding the forced taper of chronic pain patients off their safe and effective opioid pain-relieving medications. That these patients were at risk for, and experiencing significant harms due to involuntary, and often very fast tapers off their opioid medications.
Rapid forced tapering can destabilize these patients, precipitating severe opioid withdrawal accompanied by worsening pain and profound loss of function. To escape the resultant suffering, some patients may seek relief from illicit (and inherently more dangerous) sources of opioids, whereas others may become acutely suicidal. Regardless of one’s view on the advisability of high-dose opioid therapy, every thoughtful clinician recognizes rapid tapering as a genuine threat to a large number of patients who are often medically complex and vulnerable. Indeed, even slower tapers should include realistic, patient-centered goals that are achievable and account for individual patient factors.
They go on to discuss that even patients who were under the CDCs recommended ceiling dose of 90MME were being force-tapered and left to suffer.
They call for policy that prohibit rapid, forced opioid tapering at all levels of health care, and compassionate, patient-centred methods of tapering IF INDICATED and the inclusion of pain management specialists at all levels of decision making regarding future opioid policies and guidelines.
This is a clear protest at the fact that the CDC guidelines were created by addiction medicine specialists NOT pain management specialists. Addiction medicine specialists do NOT understand chronic pain, nor how to treat it safely and effectively. While this sounds ludicrous, that pain management specialists would not be included in opioid prescribing guidelines for chronic pain, the same thing has happened in Australia, where our latest Opioid Deprescribing guidelines were created by pharmacists and Addiction medicine doctors, NONE of whom know anything about how to treat chronic pain.
The consortium of pain management experts conclude:
We therefore call for an urgent review of mandated opioid tapering policies for outpatients at every level of health care—including prescribing, pharmacy, and insurance policies—and across borders, to minimize the iatrogenic harm that ensues from aggressive opioid tapering policies and practices
Sadly, not much changed despite many of the top pain management experts in the world being involved in this statement. It did contribute to the CDC issuing a statement about its 2016 prescribing guidelines, stating that their guidelines had been misinterpreted. Which was too little, too late.