Pain and Addiction Leaders Raise Alarm on Oregon Force Tapering Opioid Proposal – by Sean Mackey, MD, PhD – Mar 2019
On Mar 14th, the Oregon HERC Task Force was going to vote to make a rule for Medicaid requiring all opioids to be tapered to zero except in a few very narrowly defined cases.
At the last minute on the morning of the vote, HERC said they were postponing the vote due to a conflict of interest they had “just learned about”. That’s a pretty flimsy excuse because the membership and the whole process of this group have been driven by conflicts of interest (of the alternative medicine community) and a vast ignorance of medicine, pharmacology, and reality.
The extreme nature of this proposal has reached a level of such preposterous cruelty that protest by medical professionals is now required to preserve some limits on the government’s practice of medicine.
…it became clear that there are times when people of good conscience cannot blindly allow bad policies to move forward unchallenged. –Sean Mackey, MD, PhD
With the incredible dedication and efforts of multiple clinicians and patients advocated for those in pain, we submitted a letter to Oregon HERC expressing deep concerns about Oregon’s proposal to force a vulnerable group of its citizens to taper off of opioids.
Special thanks go out to Andrea Anderson, Dr. Stefan Kertesz, Kate Nicholson, and Dr. Beth Darnall who did most of the heavy lifting. We submitted the letter for today’s meeting, March 14, 2019 and released the following press release below.
The full letter can be found here: Oregon HERC 3-7-19
I acknowledge and respect the State of Oregon’s authority to develop and enforce their own policies. But…
I cannot ignore state policies that propose to experiment on its population
- based on faulty or absent data,
- that is devoid of a plan for careful patient protections, and
- devoid of a plan to address the unintended consequences, and
- with no clear means of monitoring the impact.
Not while I breathe and can protest.
Our patients deserve better.
PRESS RELEASE
On March 14, the Oregon Health Authority will vote on a proposal that would force Medicaid patients off opioid medications without their consent.
The move, which would affect patients with more than 170 medical conditions, is an unprecedented attempt by a state government to arbitrarily deny opioid analgesic medications to broad classes of patients without regard for their individual conditions or if they have benefited from this class of medicine.
The expert letter, whose signatories included the current and several former presidents of professional medical associations and leaders of patient advocacy groups, characterized the policy as being scientifically unsound.
The Centers for Disease Control, the Federation of State Medical Boards, and all other government or professional guidelines on opioid prescribing do not recommend forced tapering patients currently on opioid therapy, other than in situations where adverse events put the patient at risk.
Non-consensual, forced opioid tapering risks destabilizing a patient’s physical and mental health in ways that have resulted in increased pain and suffering, disability, and even suicide.
Oregon’s proposal may also place physicians in the untenable position of having to choose between violating the ethics of their profession – to do no harm – or complying with the state-issued mandate.
The experts also warned Oregon Health Officials of the dangers of proceeding with this untested practice, especially as the state lacks the infrastructure to ensure that patients would be carefully monitored, supported, and cared for during or after any forced, non-consensual opioid taper.
The risks of involuntary tapering and the importance of facilitating access of medications to patients who need themhave been highlighted by a growing chorus of health experts from many sides of the opioid debate, such as the American Medical Association and media outlets such as
- the New York Times,
- Reuter’s,
- Los Angeles Times, and
- Medpage.
Oregon’s forced tapering proposals, in particular, have garnered attention as the most aggressive in the nation.
This is the result of the escalating restrictions proposed by politicians trying to outdo each other in their crackdown on all opioids, regardless of their source and ignoring the many obvious differences between prescription medication and street drugs.
The international watchdog organization, Human Rights Watch, highlighted Oregon’s forced tapering proposals in its recent report outlining human rights violations in pain care, as have the opinion pages of the New York Times and the Wall Street Journal.
The authors of the letter concluded: “(Oregon’s proposal) is a large-scale experiment on medically, psychologically, and economically vulnerable Oregonians, at a moment when Oregon has already seen a significant reduction in opioid prescribing and prescription opioid-related deaths.”
EDS and Chronic Pain News & Info 
“…a level of such preposterous cruelty…” Beautifully put.
“large-scale experiment ” Absolutely. And the sadists have officially –& proudly– proclaimed that they are, in fact, experimenting on the state’s most vulnerable & powerless people: https://clinicaltrials.gov/ct2/show/NCT03393143
In my many years of doing basic research, I did work on rats & mice (tho I loathed it & tried like mad to avoid it & stick to tissue culture, micro- & molecular biology, etc). There was a very long & detailed training program to make sure that everyone who worked with research animals knew the ethical regulations to try & minimize the discomfort –physical AND psychological– inflicted on the vulnerable & helpless population of rats, mice, etc. For example, one requirement was, when you had to –painlessly!– ‘sacrifice’ an animal, you had to do it in a completely separate room, out of sight, sound, & smell of the others, lest they experience it vicariously. They watched us very closely, & people who violated any of the regs got fired (which, considering they were state employees who otherwise can stay in a job for years despite the grossest incompetence, is a sure sign of how serious they are about it).
These Oregon fanatical sadistic zealots have no such compunctions about subjecting their human experimental animals to unlimited physical, psychological, & social torture & abuse. Indeed, from hearing & reading remarks they’ve made on the record at their meetings, they consider pain patients (read, “parasitic worthless addicts”) so far beneath contempt or mercy that we deserve any suffering & torture we get, as a moral & spiritual character-building exercise. And they are PROUD of this stance.
I was at the meeting when the revelation of this little COI snag appeared…and my oh my, were they irritated. At one point in the discussion, the chair proposed that they basically just ignore the whole thing, pass the proposal, & hope that nobody noticed so they wouldn’t have to waste any more time on the whole stupid tedious subject of COI. I understand, to a degree, why they’d think that way: the entire group is one big mob of nothing BUT conflicts of interest, & without some incredibly sharp folk keeping on eye on them & tracking them down in their secretive lairs, they’d have passed the proposal over a year ago.
And Zyp, you’re totally correct: they’re proud of the idea that they’re going to lead the nation in draconian regs (read, “sucking government money out of the hysterical opioid ‘crisis'”) & want this insane proposal to be the blueprint for all other states. Oregon very rarely gets a chance to be #1, except maybe in its population of hard-line fundamentalist anti-science anti-vaxxers (https://www.apnews.com/26fcd1adcc7246a3adaa2166311c775b).
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