Pain Experts Speak Out Against Forced Opioid Tapering

Pain Experts Speak Out Against Forced Opioid Tapering – Pain Medicine News – Dec 2018

The tone of this article is very pain-patient-centric and finally shows sympathy for our plight.

Appearing in a mainstream medical newsletter will give our cause far more visibility than what we publish on sites devoted to our cause, so I feel this is a positive sign that the media narrative is starting to shift.

I believe we’ll be seeing less of the outdated and outright wrong “innocent people getting hooked on prescription opioids” stories to more stories about Rx opioids denied to pain patients while others overdose on injected illicit opioids freely available on the black market.  

Calling it a “large-scale humanitarian issue,”

This is an unusually extreme statement pointing out exactly how serious the situation has become as more deprived pain patients are committing suicide.

a group of pain medicine experts has written a commentary

The group of 4 is notable because it includes David Juurlink, MD, who has been vocally anti-opioid, and Beth D. Darnall, PhD, who led the “your pain is just catastrophizing” movement for years and has only recently come around to supporting our need for opioids. 

I must credit Beth D. Darnall, PhD, for her high-visibility opposition to how her own studies were used to justify forced tapers. Her support is now significant, as shown in these articles:

expressing concern over the practice of forced opioid tapering for the 18 million chronic pain patients receiving long-term opioid therapy.

The authors of the piece (Pain Med, pny228) also spoke out against opioid tapers involving “aggressive opioid dose reductions over a defined period,” even in those occurring over an extended period of time.

Guidelines for opioid tapering were created, partly, to make high-dose opioid therapy for chronic pain safer, according to the pain experts.

However, the writers of the commentary described “countless ‘legacy’ patients”with chronic pain who were slowly brought up to high doses of opioids (“often over many years”) and then put in the dangerous position of quickly tapering down from those agents.

The commentary authors called the rapid reduction of such opioid doses “aggressive and unrealistic.”

Wow, this is a strongly-worded criticism of the forced tapers coming from some of the people who initially seemed to encourage this exact practice.

The pain experts stated that studies with data to support rapid decreases of opioid doses “were conducted in highly structured, supportive, interdisciplinary, inpatient settings or ‘detox’ programs,” not in the general community.

I’m still angry that the researchers involved in these studies didn’t protest publicly and loudly and immediately when their studies were misrepresented by media headlines and anti-opioid zealots.

They sat by silently for years while their studies were used to mandate forced tapers.

Only now, 2 1/2 years after the CDC guidelines were released and immediately misinterpreted and weaponized, are the finally speaking up.

I think all the pain patient suicides are directly attributable to what they wrote and publicized and allowed to be misconstrued as a mandate to lower or eliminate opioid prescriptions for legitimate pain patients.

They indirectly caused all those deaths, and I think they are finally starting to feel some responsibility.

I don’t suppose there’s much point in continuing my tirades against these folks now that they’re starting to come around. The past is the past and there’s nothing we can do about those we lost.

However, we can honor them by continuing our struggle to resolve this “humanitarian crisis” with whatever allies are willing to help, regardless of their past positions.

“The methods by which a taper is conducted matter greatly,” they wrote.

The authors called for a review of outpatient opioid-tapering policies “at every level of care,” as well as for the Department of Health and Human Services to:

  • develop policies that end or curb rapid, forced opioid tapering of legacy opioid prescriptions;
  • provide careful selection, methods, monitoring and triaging of adverse events, and evidence-based goals for dosing;
  • create health systems committed to providing safe and effective pain care; and
  • include pain management specialists at every level of opioid decision making.

This is an excellent list, directly opposed to how the CDC guideline was formulated.

Authors of the commentary include:

  • Beth D. Darnall, PhD, a clinical professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University School of Medicine, in California;
  • David Juurlink, MD, PhD, FRCPC, FAACT, FACMT, a pharmacist and an internist in the Division of Clinical Pharmacology and Toxicology at the University of Toronto;
  • Robert D. Kerns, PhD, a professor of psychiatry, neurology and psychology at Yale University, in New Haven, Conn.; and
  • Sean Mackey, MD, PhD, the chief of the Division of Pain Medicine and Redlich Professor of Anesthesiology, Perioperative and Pain Medicine, Neurosciences and Neurology at Stanford University.

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