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Forcing patients from opioid pain relief can sometimes be more dangerous than good, international medical experts warn in an open letter to health authorities.
The letter, published in the journal Pain Medicine, outlines the risks associated with the forced reduction of drugs and the petition of US policy makers to develop guidelines that are not "aggressive and unrealistic."
Nearly 18 million Americans are long-term users of opioids due to chronic illness. After the crisis of opioid addiction which has claimed thousands of lives, health regulators and the medical community have doubled to reduce the number of opioid pills prescribed for patients.
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The U.S. Centers for Disease Control and Prevention advocates for tapering and, in some cases, stops opioids in patients who use them as long-term therapy for chronic pain.
However, in their letter, Beth Darnall from Stanford University in California and co-authors said the reduction in mandatory opioids requires a reduction in "aggressive" doses during the specified period, even when that period is an extension, it could be a problem.
They called for "a system of compassion for opioid tapering" in carefully selected patients, with close monitoring and realistic goals. They also called for a "patient advisory board. . . to ensure that a patient-centered system is developed and patient rights are protected. "
"The assumption that forced opioid taper is beneficial is not supported by evidence, and clinical experience shows a significant danger," said Ajay Manhapra from Yale University, who co-wrote the letter.
For example, the letter noted, rapid forced tapering can make the patient unstable, cause pain to worsen, trigger severe opioid withdrawal symptoms and cause deep loss of function.
Some patients may seek help with prohibited, and more dangerous sources of opioids, while others risk becoming "acute suicide," the paper added.
"With a culture of opioid tapering, pain specialists make murders," Manhapra said. "Our clinical experience is that with rapid reductions, health care costs rise due to excessive use of other expensive services such as emergency rooms and spine specialists."
"Whether it's taper fast or taper slow, the big question is – well, what did you do after that?" Said Dr. Richard Blondell, vice chairman of addiction medicine at the University at Buffalo in New York, who was not among the authors of the letter.
"What we really need is better science, not more politics. . . In my experience, when you have a global recommendation based on the opinions of experts and you try to apply it to each patient in an individual clinic, there are many things missing in the translation. "
READ MORE: 2,066 Canadians die from opioid overdoses in the first half of 2018
The letter petitioned the U.S. Department of Health and Human Services. to consider patient data and include pain specialists when developing opioid tapering guidelines.
Manhapra believes that responsibility remains for policy makers.
"It seems the storm blew in one direction from 1980 to 2016 and is now blowing very hard, while we (doctors) stand staggering in the same place trying to care for our suffering patients," he said.
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