Changing the Conversation About Opioid Tapering

Editorials1 August 2017Changing the Conversation About Opioid TaperingDeborah Dowell, MD, MPH and Tamara M. Haegerich, PhDDeborah Dowell, MD, MPHFrom Centers for Disease Control and Prevention, Atlanta, Georgia. and Tamara M. Haegerich, PhDFrom Centers for Disease Control and Prevention, Atlanta, Georgia.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-1402 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Research has uncovered potential harms of long-term opioid therapy, particularly at high dosages (1). These findings make it clear that before starting long-term therapy or increasing dosages, clinicians and patients need to carefully weigh the uncertain benefits of opioids for chronic pain against their increasingly clear risks (2, 3). However, little evidence has been available to help weigh the benefits and harms of reducing dosages or discontinuing opioids in patients already receiving long-term therapy or to guide clinicians in how to taper opioids safely and effectively (4). Frank and colleagues' review (5) provides helpful information for clinicians and patients about ...References1. Chou R, Turner JA, Devine EB, Hansen RN, Sullivan SD, Blazina I, et al. The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med. 2015;162:276-86. [PMID: 25581257]. doi:10.7326/M14-2559 LinkGoogle Scholar2. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016. JAMA. 2016;315:1624-45. [PMID: 26977696] doi:10.1001/jama.2016.1464 CrossrefMedlineGoogle Scholar3. U.S. Department of Veterans Affairs; U.S. Department of Defense. VA/DoD Clinical Practice Guideline for Opioid Therapy for Chronic Pain. Washington, DC: U.S. Department of Veterans Affairs and U.S. Department of Defense; 2017. Accessed at www.healthquality.va.gov/guidelines/Pain/cot on 11 May 2017. Google Scholar4. Berna C, Kulich RJ, Rathmell JP. Tapering long-term opioid therapy in chronic noncancer pain: evidence and recommendations for everyday practice. Mayo Clin Proc. 2015;90:828-42. [PMID: 26046416] doi:10.1016/j.mayocp.2015.04.003 CrossrefMedlineGoogle Scholar5. Frank JW, Lovejoy TI, Becker WC, Morasco BJ, Koenig CJ, Hoffecker L, et al. Patient outcomes in dose reduction or discontinuation of long-term opioid therapy. A systematic review. Ann Intern Med. 2017;167:181-91. doi:10.7326/M17-0598 LinkGoogle Scholar6. Dowell D, Zhang K, Noonan RK, Hockenberry JM. Mandatory provider review and pain clinic laws reduce the amounts of opioids prescribed and overdose death rates. Health Aff (Millwood). 2016;35:1876-1883. [PMID: 27702962] CrossrefMedlineGoogle Scholar7. Rollnick S, Miller WR, Butler CC. Motivational Interviewing in Health Care: Helping Patients Change Behavior. New York: Guilford Pr; 2008. Google Scholar8. Seal K, Becker W, Tighe J, Li Y, Rife T. Managing chronic pain in primary care: it really does take a village. J Gen Intern Med. 2017. [PMID: 28337689] doi:10.1007/s11606-017-4047-5 CrossrefMedlineGoogle Scholar9. Centers for Disease Control and Prevention. CDC Guideline for Prescribing Opioids for Chronic Pain. Guideline Resources. Atlanta: Centers for Disease Control and Prevention; 2016. Accessed at www.cdc.gov/drugoverdose/prescribing/resources.html on 26 May 2017. Google Scholar10. Agency for Healthcare Research and Quality. Noninvasive, Nonpharmacological Treatment for Chronic Pain. Rockville: Agency for Healthcare Research and Quality; 2017. Accessed at http://effectivehealthcare.ahrq.gov/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=2470 on 26 May 2017. Google Scholar Author, Article, and Disclosure InformationAffiliations: From Centers for Disease Control and Prevention, Atlanta, Georgia.Disclaimer: The conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-1402.Corresponding Author: Deborah Dowell, MD, MPH, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS F-62, Atlanta, GA 30341; e-mail, [email protected]gov.Current Author Addresses: Drs. Dowell and Haegerich: Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS F-62, Atlanta, GA 30341.This article was published at Annals.org on 11 July 2017. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoPatient Outcomes in Dose Reduction or Discontinuation of Long-Term Opioid Therapy Joseph W. Frank , Travis I. Lovejoy , William C. Becker , Benjamin J. Morasco , Christopher J. Koenig , Lilian Hoffecker , Hannah R. Dischinger , Steven K. Dobscha , and Erin E. Krebs Metrics Cited byReducing Superfluous Opioid Prescribing Practices After Brain Surgery: It Is Time to Talk About DrugsIdentifying opioid dose reductions and discontinuation among patients with chronic opioid therapyImplementation of an emergency department discharge opioid taper protocolAssociation Between Opioid Dose Reduction Against Patients' Wishes and Change in Pain SeverityBest Practices, Research Gaps, and Future Priorities to Support Tapering Patients on Long-Term Opioid Therapy for Chronic Non-Cancer Pain in Outpatient Settings"It Sometimes Doesn't Even Work": Patient Opioid Assessments as Clues to Therapeutic Flexibility in Primary CareIndication-Specific Opioid Prescribing for US Patients With Medicaid or Private Insurance, 2017"Chasing the pain relief, not the high": Experiences managing pain after opioid reductions among patients with HIV and a history of substance useFull agonist opioid prescribing by primary care clinicians after buprenorphine trainingTackling rising numbers of opioid prescriptions usersOpioid Taper Is Associated with Subsequent Termination of Care: a Retrospective Cohort StudyResponse to Propoxyphene Market WithdrawalRethinking Opioid Dose Tapering, Prescription Opioid Dependence, and Indications for BuprenorphineRoger Chou, MD, Jane Ballantyne, MD, and Anna Lembke, MDNo Shortcuts to Safer Opioid PrescribingPrescribing, Prescription Monitoring, and Health PolicyPerspectives on the opioid crisis from pain medicine clinicians 1 August 2017Volume 167, Issue 3Page: 208-209KeywordsExercise therapyOpioid use disorderOpioidsPain managementPatientsQuality of lifeResearch quality assessmentSafetySystematic reviewsVeteran care ePublished: 11 July 2017 Issue Published: 1 August 2017 PDF downloadLoading ...