While many doctors say they aren’t confident they can safely help patients taper long-term opioid use, the government has come out with a new guide.
The U.S. Department of Health and Human Services announced Thursday that it has published a new guide with recommendations for appropriately tapering or discontinuing long-term opioid use.
The five-page guide (PDF) provides advice to doctors and other clinicians who are contemplating or initiating a reduction in a patient’s opioid dosage or discontinuing long-term opioid therapy for chronic pain. In each case, clinicians should consider the risks and benefits of the current therapy with the patient and decide if tapering opioids is appropriate for that individual, the guide said.
In a recent survey, 86% of physicians agreed that helping people get off of opioids is a fundamental part of stopping the country’s epidemic. However, a quarter of them said they weren’t confident they can safely get patients off the addictive drugs.
Some 80% of physicians say there is a lack of education about how to help their patients stop taking opioid painkillers, according to a new national survey from US WorldMeds.
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In an announcement about the new guide, HHS said once a patient is on opioids for a prolonged duration, any abrupt change may put the patient at risk of harm and should include a thorough, deliberative case review and discussion with the patient.
“Care must be a patient-centered experience. We need to treat people with compassion, and emphasize personalized care tailored to the specific circumstances and unique needs of each patient,” said Adm. Brett P. Giroir, M.D., assistant secretary for health at HHS, in an announcement. “This guide provides more resources for clinicians to best help patients achieve the dual goals of effective pain management and reduction in the risk for addiction.”
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HHS said a reduced opioid dosage may be indicated in certain situations and should be in joint consultation with the care team and the patient. HHS does not recommend opioids be tapered rapidly or discontinued suddenly due to the significant risks of opioid withdrawal unless there is a life-threatening issue confronting the individual patient.
The guide, which was compiled from published guidelines and practices endorsed in the peer-reviewed literature, covers issues clinicians should consider when changing a patient’s chronic pain therapy, HHS said. It lists issues to consider prior to making a change, which includes shared decision-making with the patient; issues to consider when initiating the change; and issues to consider as a patient’s dosage is being tapered, including the need to treat symptoms of opioid withdrawal and provide behavioral health support.