Is there really NO benefit to non-consensual opioid taper?

[drusso]

Suggested Paths to Fixing the Opioid Crisis—Directions and Misdirections

"One seductive target for action is restraint of opioid prescriptions: their dose, duration, and formulation.4 A case can be made that risk will be attenuated by attacking all 3 aspects of prescribing, and policy makers and regulators have taken up this solution with enthusiasm. However, such regulatory efforts have also inaugurated a tide of nonconsensual tapers in otherwise stable patients, for which evidence of benefit is lacking5 and reports of harm are concerning."

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[Aether2000]

If the physician takes the position that only consensual tapers are warranted, then the physician is nothing more than a connection/a bag man/a peddler/ a candy man. Therefore the only legitimate position is that the physician elects to wean the patient, with or without their assent or their consent.

 

[Ducttape]

It is not the physicians pen, as lobel calls it - it is the patient’s.

We used to laugh when a patient would find a blank script and write for “1 pound mopheen”.

How long before pharmacies are required to fill these?

 

[Ducttape]

Oh it’s Kertesz again. The VA addiction doc who wrote no prescriptions in Medicare in 2015, working at one of the top opioid prescribing VAs - and has no skin in the game.

 

[drusso]

Anna Lembke, MD, says non-consensual taper is the only way to go. Is she right?

Stanford’s Lembke: Most high-dose opioid patients should be tapered down—even involuntarily.

"You said we can’t leave this up to “patients or their individual doctors.” I’m surprised to hear you say that we don’t even leave this up to the doctor. Who decides then?

Over 70 percent of physicians and other prescribers today work as salaried employees in large integrated health care systems. This is a huge change from 30 years ago when most physicians were self-employed. We are, in essence, factory workers. And the structure in which we work has a huge impact on how we practice medicine. It’s now protocolized. There are patient satisfaction surveys. At the end of every month I get a graphic showing me how much I’ve billed, and whether or not I’ve met my targets. This is a totally different beast we’re dealing with."

 

[lobelsteve]

Anna Lembke, MD, says non-consensual taper is the only way to go. Is she right?

Stanford’s Lembke: Most high-dose opioid patients should be tapered down—even involuntarily.

"You said we can’t leave this up to “patients or their individual doctors.” I’m surprised to hear you say that we don’t even leave this up to the doctor. Who decides then?

Over 70 percent of physicians and other prescribers today work as salaried employees in large integrated health care systems. This is a huge change from 30 years ago when most physicians were self-employed. We are, in essence, factory workers. And the structure in which we work has a huge impact on how we practice medicine. It’s now protocolized. There are patient satisfaction surveys. At the end of every month I get a graphic showing me how much I’ve billed, and whether or not I’ve met my targets. This is a totally different beast we’re dealing with."

Perfect storm to fire all docs and let the PAs and nurses take over all of healthcare.

Idiots.

 

[Ducttape]

A good counter argument to the Kertesz of the world.

It is still your pen, right, Steve?

 

[lobelsteve]

A good counter argument to the Kertesz of the world.

It is still your pen, right, Steve?

I'm going through more pens these days. 5-10 times per day I talk to patients about why opiates are not right for them. I end with humor and try and throw my pen under the door into the hallway. I'm shooting 20%. But I'm having fun doing it.

The person and not the drug. Always.
Pain patients are not all addicts.
All addicts were not pain patients.
The job is the same. Don't Rx if you are not comfortable with it.
Trust but verify with serial due diligence.
Be a caring physician, but not a door mat.

 

[Aether2000]

The Corollaries:

Pain patients are not all addicts but many have become chemically dependent on the opioids we prescribe.

Since we cannot see pain, measure pain, nor have an objective assessment of either the presence of pain or degree of pain, we are 100% dependent on the completely subjective patient self-assessment of what they want us to believe their pain is on a given day.

All addicts were not pain patients but most addicts have feigned pain or continue to do so in order to obtain opioids.

You cannot trust a completely subjective self-assessment, so distrust and force 100% compliance with clinic rules and UDT.

Care enough about your patients that you will find alternatives to opioids and move them all off high dose opioids.

Think homeopathic doses of opioids.

 

[Ferrismonk]

All my tapers are voluntary. "This is the treatment I'm willing to offer, I understand how frustrating it is, but this is the best I can do. You are welcome to get a second opinion or find someone else that may better suit your needs". Patient accepts taper.