The Trump administration on Thursday instructed doctors to use more caution when taking chronic pain patients off opioid medications, a response to reports that many have been cutting off prescriptions too quickly, in some cases even dismissing patients from their practice.
The Department of Health and Human Services published a guide intended to be a course correction of sorts. In 2016, after years of rising addiction rates and deaths from prescription painkiller overdoses, the Centers for Disease Control and Prevention issued nonbinding guidelines for primary care doctors that urged more cautious prescribing. A backlash ensued, particularly from some doctor and patient groups who said the guidelines were hurting people with severe chronic pain, many of whom had been on high doses of opioids for years without becoming addicted.
After more than 300 medical providers, pharmacists, patient advocates and others emphasized these concerns in a letter to the C.D.C. earlier this year, the agency put out a clarifying statement saying the guidelines did not “support abrupt tapering or sudden discontinuation of opioids,” and warning doctors not to misapply them.
The new tapering guide goes deeper, detailing the potential harms to patients who abruptly stop taking opioids and laying out factors to consider and steps to take before starting a taper. It includes several examples of tapering protocols.
“We need to maintain a balance,” said Adm. Brett P. Giroir, the department’s assistant secretary for health, adding that “it is a false choice to say we could only limit opioid use disorder or addiction or have pain control.”
Annual opioid prescriptions in the United State peaked at 255 million in 2012 after increasing every year for more than a decade — a rise that fueled the epidemic of overdose deaths that continues to plague the nation. But by 2017, the number of opioid prescriptions had fallen to 191 million, a drop that President Trump has pointed to as a victory, even as his administration has begun responding to chronic pain patients angry about being forced off the drugs.