New Guidelines On Opioid Tapering Tell Doctors To Go Slow

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Amid controversy and confusion over the use of prescription opioids to treat chronic pain, the federal government on Thursday published new guidelines on how, when and whether the millions of patients who use the painkillers should be forced to cut back.

The main point of the new guidance on tapering is that clinicians should be slow, cautious and deliberate in reducing dosages and should consult patients to ensure they are tolerating the process. The guidelines emphasize “personalized care tailored to the specific circumstances and unique needs of each patient,” said Brett P. Giroir, an assistant secretary for health at the Department of Health and Human Services.

Millions of people in the United States — an estimated 3 to 4 percent of the adult population — take opioids daily. About 2 million people have been diagnosed with prescription opioid use disorder, according to HHS. There is a consensus in the medical community that these painkillers have been overprescribed and that many patients would have better long-term health outcomes if they cut back on their dosages and took advantage of other types of treatment, ranging from physical therapy to nonnarcotic painkillers.

People who have been forced by their doctors to cut back rapidly on their medication may experience heightened pain and may suffer psychological distress, the new HHS guide for clinicians states. Clinicians are advised to monitor patients closely for signs of anxiety and suicidal ideation.

“Risks of rapid tapering or sudden discontinuation of opioids in physically dependent patients include acute withdrawal symptoms, exacerbation of pain, serious psychological distress and thoughts of suicide. Patients may seek other sources of opioids, potentially including illicit opioids, as a way to treat their pain or withdrawal symptoms,” states the HHS guide.

The overuse of these pills and patches has fueled an opioid epidemic that claims more lives every year in the United States than automobile accidents or gun violence. In the past decade, medical experts have come to realize the potentially dire consequences — addiction, for starters, overdoses, and death in the worst-case scenarios — of prescribing these narcotics for ailments other than cancer, recent surgery or end-of-life palliative care.

A 2016 guidance from the CDC set standards for prescribing of opioids. Officials later acknowledged that many medical professionals misinterpreted the guidelines.

The CDC, for example, had suggested an upper limit for opioid dosages among new patients. But many patients were already taking more than that, and their doctors tried to cut dosages to the CDC recommendation. The CDC clarified the guidance earlier this year to say that it only applied to new patients, not existing ones, who should not be tapered rapidly to a lower dose.

The Washington Post

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