Sometimes doctors rapidly taper their chronic pain patients’ opioid doses. Now a federal agency recommends against this.
There’s no doubt that opioids have been massively overprescribed in U.S. In the haste to address the epidemic, there’s been pressure on doctors to reduce prescriptions of these drugs — and in fact prescriptions are declining. But along the way, some chronic pain patients have been forced to rapidly taper or discontinue the drugs altogether.
Now, the U.S. Department of Health and Human Services has a new message for doctors: Abrupt changes to a patient’s opioid prescription could harm them.
The agency issued new guidelines for physicians on how best to manage opioid prescriptions. They recommend a deliberate approach to lowering doses for chronic pain patients who have been on long-term opioid therapy.
“It must be done slowly and carefully,” says Adm. Brett P. Giroir, MD, assistant secretary for health for HHS. “If opioids are going to be reduced in a chronic patient it really needs to be done in a patient-centered, compassionate, guided way.”
This is a course correction of sorts. In 2016, the Centers for Disease Control and Prevention issued prescribing guidelines. Those highlighted the risks of addiction and overdose and encouraged providers to lower doses when possible. In response, many doctors began to limit their pain pill prescriptions, and in some cases cut patients off.
These guidelines led to rigid rules in some cases. Giroir says it’s concerning that some clinicians, policymakers, and health systems are “interpreting guidelines as mandates.”
“A guideline is a guideline it’s not a mandate or a rule that works for every single patient,” he says.
The new HHS guidance cautions that a hasty removal of the medication can lead to acute withdrawal symptoms, provoke thoughts of suicide and lead patients to seek out illicit opioids “as a way to treat their pain or withdrawal symptoms.”
Entirely discontinuing opioids for a chronic pain patient is not always appropriate, according to the guidelines: “Unless there are indications of a life-threatening issue, such as warning signs of impending overdose, HHS does not recommend abrupt opioid dose reduction or discontinuation.” Giroir says the agency’s move to issue these guidelines is a reflection of the current data. “There is a very large body of data across the scientific and medical literature that would say that abrupt discontinuation or abrupt reduction in dosage can be harmful to patients,” says Giroir.
Still, he says the evidence shows that “a majority of patients can have a reduction in opioids and improve pain control at the same time.” The new tapering guidance follows earlier efforts to signal that too much emphasis on reducing opioids for chronic pain patients may backfire.
