large-scale humanitarian issue: forced opioid tapering in patients receiving long-term prescription opioid therapy for chronic pain

International Stakeholder Community of Pain Experts and Leaders Call for an Urgent Action on Forced Opioid Tapering

https://academic.oup.com/painmedicine/advance-article/doi/10.1093/pm/pny228/5218985

We, the undersigned, stand as a unified community of stakeholders and key opinion leaders deeply concerned about forced opioid tapering in patients receiving long-term prescription opioid therapy for chronic pain. This is a large-scale humanitarian issue. Our specific concerns involve:

  • rapid, forced opioid tapering among outpatients;
  • mandated opioid tapers that require aggressive opioid dose reductions over a defined period, even when that period is an extended one.

Opioid tapering guidelines were created, in part, to decrease harm to patients resulting from high-dose opioid therapy for chronic pain. However, countless “legacy patients” with chronic pain who were progressively escalated to high opioid doses, often over many years, now face additional and very serious risks resulting from rapid tapering or related policies that mandate extreme dose reductions that are aggressive and unrealistic.

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.

New and grave risks now exist because of forced opioid tapering: an alarming increase in reports of patient suffering and suicides within and outside of the Veterans Affairs Healthcare System in the United States.

Reports suggest that forced tapering is also occurring in patients on opioid doses below the Centers for Disease Control and Prevention Opioid Guideline threshold of 90 morphine equivalent daily dose. These patients too are at risk of harm from overly aggressive tapering.

Patients on legacy opioid prescriptions require different considerations and careful attention to the methods by which opioid tapers might be considered and implemented. Currently, no data exist to support forced, community-based opioid tapering to drastically low levels without exposing patients to potentially life-threatening harms. Existing data that support rapid reductions of opioid doses—often to zero—were conducted in highly structured, supportive, interdisciplinary, inpatient settings or “detox” programs in which medications and other approaches were used to minimize the symptoms of withdrawal. These data do not inform community-based opioid tapering. Currently, nonconsensual tapering policies are being enacted throughout the country without careful systems that attend to patient safety. The methods by which a taper is conducted matter greatly.

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.

Almost 18 million Americans are currently taking long-term prescription opioids. We ask the Department of Health and Human Services to consider the following to mitigate harms in this special, at-risk population:

  • Enact policies that prohibit or minimize rapid, forced opioid tapering in outpatients taking legacy opioid prescriptions (this includes prescribers and health care organizations, pharmacies, and insurance payors).
  • Provide compassionate systems for opioid tapering, if indicated; that includes careful selection, patient-centered methods, close monitoring, triaging of adverse events, and realistic end-dose goals that are evidence-based and derived from applicable outpatient tapering data.
  • Convene patient advisory boards at all levels of decision-making to ensure that patient-centered systems are developed and patient rights are protected within the context of pain care.
  • Require inclusion of pain management specialists at every level of decision-making about future opioid policies and guidelines.

In standing as a unified community of concerned scientists, experts, citizens, and leaders of pain organizations in our respective countries, we call for the development and implementation of policies that are humane, compassionate, patient-centered, and evidence-based in order to minimize iatrogenic harms and protect patients taking long-term prescription opioids.

5 Responses

  1. Most Heroin Opiate Overdoses are happing because of bad Heroin mixed with Fentanyl are coming from War Lords that are being protected by our Military and now from Afghanistan Poppy Plants are their main source of Money now that War has ripped them apart . So the Feds are switching the blame to us so I have taken this opportunity to share my heartbreaking story in hopes these witch hunting Opiate ill informed skeptics will read and understand that I would have no life without Medically prescribed Opiates by a physicians care and strictly monitored monthly urine and blood test. Please remember that An Opinion Before A Thorough Investigation Is The Epitome Of Ignorance! And that a little more compassion from the Medical Field and its representatives could have saved my beautiful Stepdaughters life. Let me say this! A person who has a addictive personality will abuse anything that helps them feel better. I have taken Oxycontin for 18 years , I have had 27 major surgery’s in 19 years. I have so much physical pain I can not even get out of bed with out pain meds and when I run out I run out and just lay in bed praying the Lord relieve me of this horrible condition and I pray God you pain med skeptics never go through what I go through everyday of my life when the only thing you have to do is threaten what help I get, Shame on you! There will always be drug abuse and as the so called war on drugs has failed all this will! All you do is stoke and aid the drug pushers business to knew heights in the Black Market of Heroin coming from War torn Afghanistan while depriving folks as me to this horrible movement!
    My Stepdaughter committed suicide 6 years ago because of being treated like a drug addict by some of her family and some friends and some doctors when all along she suffered from Lupus and Fibro which I believe was brought on by a deadly car crash at 18 , she told me between that which I was being put through and what they were putting her through she was not going to live her life in such a hell brought on by people like you that are on a witch hunt to out law Opiates and pain meds that give us some sort of a life . As a retired Police officer and worked indirectly close to the DEA and the A.T.F., You people do not have a clue how thrilled you are making the illegal opiate trade from Afghanistan a CASH COW for War Lords! And think of my Late Stepdaughter as you continue on with this 2018 Version of the ( 1940s Propaganda Film named REEFER MADNESS )movement to outlaw opiates! Just like the slaughter of children at Sandy Hook if there would have just been gun laws , my God they were Gun Laws , the guns that murdered all those 20 children were all registered and owned by a school teacher! You fight Drug Addiction in Elementary education by teaching all children the dangers of Booze and Tobacco which if these witch hunters want for us to know the real truth but they do not. I miss my Stepdaughter so much and some of us will continue on the fight to protect our right to feel better and function without fear of these witch hunters trying to convince us to commit suicide . And they are trying to do exactly THAT!
    The under line real truth is THESE witch hunters would rather us Chronic Pain sufferers commit suicide are and DRINK all the BOOZE we can drink! The Federals legalized it ( ALCOHOL) knowing its a more deadly drug than Strychnine. And just because the DEA has miserably failed with their witch hunt type movement on drugs why do they deprive us sick people of our Constitutional Rights to be Happy in that pursuit of with Professional Physicians to take meds that give us relief of this horrible malady of Chronic Pain ! May God have mercy on their miserable souls they that seek to destroy us Chronic Pain Sufferers only and little hope of temporary relief of this horrible sickness. Below a picture of me and my Deceased Beautiful Stepdaughter one year before her Suicide! Such a horrible tragedy !The last couple of sentences on Sissys last email , well you read it I should have done more but( I guess the jury is still out ?
    ( So I am resolving that situation very soon I am just looking for the right time,Physically,I am in pain and ready to come home. I hurt and want to be in my own bed.
    Love you ,See you soon. Tell your Mom I love her too. And that was it .

  2. I Am Very Concerned And Confused By The Whole Issue. How Is “SLOW” Tapering Supposed To Help Pain Patients With Chronic Painful Diseases Anyway ? TAPER To What ?, For What ? There is Also The Issue Of Those Of Us With Co-ocurring Diagnosis Such As Anxiety Disorder Being Both Denied And Forced Off Benzos As Well, .And The Other Serious Issue I’ve Been Complaining Of For Years Regarding The Lies, Misrepresented And Non Standardized ADHD Frauds. When Will This Crime End ? And What Is Supposed To Be The End Result ? More Experimentation, Heavy Metals, Lab Rat Nano Management And Remote Militaristic Control Exposing Us To “Smart” Dust, BIOCHIPS, Implants, All Because Of A Lie, Propaganda And Further Massacre Of All Of Our RIGHTS ? What Happens Next, When We’re Dealing With Psychopaths Who Thrive Off Of Our Pain, Suffering, And Incapacity To Attain QOL And Independence ? All The While Rolling-Out The 5G Cancer Nukes, Upping The Frequencies On A Scale Unprecedented And Solely For The Purpose Of Serving Monetary And Control Paradyms. I’m Sickened by The Passive Acquiesce To What Authority Figure’s ? It’s Like Asking PERMISSION To Not Be Slowly Terrorized And Tortured. It-They Are Not God And I Cannot Live In A World Ruled By A Few Insanely And Dangerously Criminally Mentally I’ll People Who Hold No Empathy, And Compassion As They Are Not Affected.

  3. Like it or not,,,The only one willing to help us has been, so-far,,,every human rights council OUTSIDE America,,,,,,maryw

  4. What’s really infuriating is that the primary target audience for this letter –the Oregon so-called chronic pain task force– is utterly uninterested in facts or opinions from anyone, even those who know a GREAT deal more than anyone on the task farce. They have less than zero interest in facts: they’ve decided on their beliefs, and like every fundamentalist zealot in every religion, facts & evidence have no part in their dogma. Too bad that things like morals, ethics, & mercy also have no part in their dogma. They view chronic pain patients with monumental contempt, and firmly believe that every one of them is an addict, liar, & malingerer who needs to have the task farce members forcibly step in & correct the errors of their ways. And if some huge number of those they force to zero (or all of them) proceed to kill themselves because of untreated, intolerable pain, the task farce will merely sneer & see it as proof that the patients were too badly addicted –and too useless– to live.

    I devoutly pray that every single task farce member immediately acquires permanent, intolerable pain, and is denied all relief.

    • Very true, they don’t care, and don’t want to know, how much they’re harming people who have no way to fight for themselves. They’ve taken our right to live in a modicum of pain relief and now they do not care if we take our own lives. It only makes their jobs easier of we do.

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