In recent years, chronic-pain patients on long-term opioid therapy have been living in fear. They fear being abruptly cut off from their medication by doctors who no longer feel comfortable prescribing opioids. They fear the prospect of withdrawal and a life of pain.

We now have evidence that these fears are eminently reasonable. Across the country, clinicians have changed their prescribing practices, requiring that patients taper abruptly to a lower dose or discontinue their opioid medication altogether, sometimes under threat of being “fired” from their clinic if they don’t comply.

I know this not only from media reports but also from recent acknowledgment of the problem from the Centers for Disease Control and Prevention and Food and Drug Administration. I also know it because patients tell me. Ever since I went public with my own account of opioid dependence and the horror I experienced in withdrawal, I’ve collected heartbreaking stories from desperate patients. I’m approached after talks by audience members who want to share intimate details of their loved ones’ pain, medical histories and eventual abandonment. Other patients send me emails or handwritten notes, desperate for advice to relieve the pain and withdrawal they’ve been left in.

This is not how cases of long-term opioid therapy should be handled; our fear of opioids should not lead clinicians to abandon or forcibly taper their patients. Fortunately, the Department of Health and Human Services has now officially agreed, issuing a Guide for Clinicians on the topic of opioid tapering. The purpose of the guide is actually twofold: It teaches clinicians how to taper chronic opioid therapy (something for which there is a clear need), but it also directs clinicians not to taper opioids abruptly and nonconsensually (and not to abandon opioid therapy patients altogether).

 

It’s worth noting how strong a stance the department is taking with this second part of the guide. A central problem with pain medicine today is that there is a population of patients who, thanks to a history of aggressive use of opioids for chronic pain, are on high doses of opioids.

 

Read more here.

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