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Pain doctors, advocates urge curbs on "forced opioid tapering" - Opioid Watch – Nonprofit News from The Opioid Research Institute
Board of Directors | Physicians for Responsible Opioid Prescribing
Kolodny also maintains that involuntary taper is sometimes appropriate, given the harms and risks of high-dose opioid therapy. (High-dose opioid therapy can cause severe constipation, depression, lethargy, cognitive decline, hormone imbalance, cardiac problems, breathing problems, increased pain, falls, car accidents, overdose, and death.)
“ ‘Forced’ sounds like a bad word,” Kolodny says. “But if the risks outweigh the benefits, you have no choice. Doctors are not vending machines.” (Kolodny co-heads the Opioid Policy Research Collaborative at Brandeis University.)
The following PROP board members agreed to share their concerns with the letter. Here are some excerpts:
Mark Sullivan, MD (pain medicine doctor and psychiatrist at the University of Washington, who has published research on opioid tapering): “Voluntary and supported taper is always best. But the boundary between voluntary and involuntary tapers can be quite fluid in practice. Some of the highest risk patients really need to be pushed toward taper. Patients with diversion or [opioid use disorder] need to be forced to taper or switch to [buprenorphine, an addiction treatment medication].”
Anna Lembke, MD (addiction psychiatrist at Stanford Medical School, who is currently leading a free, online continuing medical education seminar on opioid tapering): “I’m a strong advocate of slow, compassionate, patient-centered opioid tapers …. But I also believe these tapers need to occur even if patients don’t want them, i.e. in some cases, they need to be ‘forced’. … Data show the large majority of high dose legacy patients will not voluntarily engage in tapering.”
Stephen Gelfand, MD (rheumatology consultant, Myrtle Beach, S.C.): “Certainly the avoidance of forced tapering in most … is indicated. But there is also a significant percentage of these patients who actually have the disease of addiction and need addiction treatment services including medication-assisted therapy [MAT] such as buprenorphine. The problem here is the difficulty in identifying these patients, who are often in denial, and/or their doctors are often reluctant to make the diagnosis of addiction or unaware of its possibility. … In view of the above, we also need to have victim advocates who have survived and overcome the scourges of addiction as the result of opioid overprescribing to sit on these patient advisory boards at every level of decision-making.”
Danesh Mazloomdoost, MD (anesthesiologist and doctor of regenerative medicine): “The wording [of the letter] feeds into a catastrophic vocabulary prevalent among chronic pain patients. … I regularly see patients who feel abandoned by their providers because of a sudden arrest in the opioids they had been prescribed for years. These patients have the impression that regulations, addiction, and physician fears of prosecution are the primary motivators for this radical change. They are entirely unaware of the scientific foundation that guides these changes …. It sets up an adversarial relationship with every clinician thereafter and further stigmatizes opioid use disorder and alternatives to opioid management. I would strongly urge a more objective letter outlining the need for clinician guidance on … (1) how to effectively converse with patients about the long-term detrimental effect of opioids and the need for tapering, and (2) methodological guidance on tapering.”
Board of Directors | Physicians for Responsible Opioid Prescribing
Kolodny also maintains that involuntary taper is sometimes appropriate, given the harms and risks of high-dose opioid therapy. (High-dose opioid therapy can cause severe constipation, depression, lethargy, cognitive decline, hormone imbalance, cardiac problems, breathing problems, increased pain, falls, car accidents, overdose, and death.)
“ ‘Forced’ sounds like a bad word,” Kolodny says. “But if the risks outweigh the benefits, you have no choice. Doctors are not vending machines.” (Kolodny co-heads the Opioid Policy Research Collaborative at Brandeis University.)
The following PROP board members agreed to share their concerns with the letter. Here are some excerpts:
Mark Sullivan, MD (pain medicine doctor and psychiatrist at the University of Washington, who has published research on opioid tapering): “Voluntary and supported taper is always best. But the boundary between voluntary and involuntary tapers can be quite fluid in practice. Some of the highest risk patients really need to be pushed toward taper. Patients with diversion or [opioid use disorder] need to be forced to taper or switch to [buprenorphine, an addiction treatment medication].”
Anna Lembke, MD (addiction psychiatrist at Stanford Medical School, who is currently leading a free, online continuing medical education seminar on opioid tapering): “I’m a strong advocate of slow, compassionate, patient-centered opioid tapers …. But I also believe these tapers need to occur even if patients don’t want them, i.e. in some cases, they need to be ‘forced’. … Data show the large majority of high dose legacy patients will not voluntarily engage in tapering.”
Stephen Gelfand, MD (rheumatology consultant, Myrtle Beach, S.C.): “Certainly the avoidance of forced tapering in most … is indicated. But there is also a significant percentage of these patients who actually have the disease of addiction and need addiction treatment services including medication-assisted therapy [MAT] such as buprenorphine. The problem here is the difficulty in identifying these patients, who are often in denial, and/or their doctors are often reluctant to make the diagnosis of addiction or unaware of its possibility. … In view of the above, we also need to have victim advocates who have survived and overcome the scourges of addiction as the result of opioid overprescribing to sit on these patient advisory boards at every level of decision-making.”
Danesh Mazloomdoost, MD (anesthesiologist and doctor of regenerative medicine): “The wording [of the letter] feeds into a catastrophic vocabulary prevalent among chronic pain patients. … I regularly see patients who feel abandoned by their providers because of a sudden arrest in the opioids they had been prescribed for years. These patients have the impression that regulations, addiction, and physician fears of prosecution are the primary motivators for this radical change. They are entirely unaware of the scientific foundation that guides these changes …. It sets up an adversarial relationship with every clinician thereafter and further stigmatizes opioid use disorder and alternatives to opioid management. I would strongly urge a more objective letter outlining the need for clinician guidance on … (1) how to effectively converse with patients about the long-term detrimental effect of opioids and the need for tapering, and (2) methodological guidance on tapering.”
