Doctors are avoiding opioids and patients who are prescribed them, despite government warnings against sudden discontinuation
Doctors are increasingly hesitant about prescribing opioids to their patients even for circumstances when the drugs are warranted and despite governmental warning about the negative effects of sudden discontinuation and tapering, according to a new report from Quest Diagnostics and the Center on Addiction.
The survey found that 81 percent of responding physicians are reluctant to take on new patients currently prescribed opioids, despite the fact that 83 percent of physicians admit that because of the ongoing opioid crisis it has become increasingly difficult to treat patients suffering from chronic pain.
This reticence is in line with a 2016 CDC guideline for prescribing opioids for chronic pain which warned of the risks of opioid use. The guideline said that no evidence showed a long-term benefit of opioids in pain and function versus treatment without the drugs with outcomes examined at least a year later, while extensive evidence showed the possible harms of opioids and the benefits of non-pharmacological and non-opioid treatments.
This came as a response to the opioid epidemic, which as of January 2019 saw 130 people dying each day of opioid overdoses. At least part of the public blame for the opioid crisis has been laid at the feet of pharmaceutical companies, many of which marketed opioids as safe and non-addictive since the late 1990s, leading to an explosion of prescriptions, according to drugabuse.gov.
But there’s evidence that physicians have pulled back prescribing opioids in a way that may be causing harm to some patients, leading health officials to clarify guidance about the 2016 CDC guidelines.
In April, the CDC and FDA clarified the guidelines by acknowledging the harm that can be caused by abruptly ceasing opioid treatment or rapid tapering in cases of chronic pain.
“These practices can result in severe opioid withdrawal symptoms including pain and psychological distress, and some patients might seek other sources of opioids,” the CDC clarification says. “In addition, policies that mandate hard limits conflict with the Guideline’s emphasis on individualized assessment of the benefits and risks of opioids given the specific circumstances and unique needs of each patient.”
The CDC clarification also includes advice to physicians treating patients receiving long-term high-dosage opioid regimens. This includes:
· Maximizing non-opioid treatment
· Empathetically reviewing risks associated with the regimens
· Collaborating with patients who agree to taper their doses
· Tapering slowly enough to minimize withdrawal symptoms
· Individualizing the pace of tapering
· Closely monitoring and mitigating overdose risk for patients who continue the regimen
These clarifications were then followed in October by a new guide on appropriate tapering or discontinuation of long-term opioid use from HHS. That guidance emphasizes that once a patient is on an opioid regimen for an extended period of time any change can put that patient at risk for harm.
“In certain situations, a reduced opioid dosage may be indicated, in joint consultation with the care team and the patient,” the new guide says. “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 physicians surveyed by Quest say they believe their peers will increasingly use non-opioid treatments for chronic pain, including 85% who say physicians will increasingly use non-pharmacologic treatments such as acupuncture, massage and physical therapy, and 58% who say physicians will use marijuana products.