“Clues” That Patients May Be Willing to Consider Opioid Reductions

As the US opioid crisis continues¹ and the limited role for long-term opioid therapy (LTOT) in chronic pain becomes ever more apparent, patient-centered, safe tapering of risky LTOT regimens has emerged as one of the most complex and challenging skills required of the general internist. However, while the Centers for Disease Control and Prevention (CDC),² the Veterans Health Administration,³ and other stakeholder organizations implore generalist prescribers to engage patients in discussions about tapers and implement them when benefits of LTOT no longer outweigh harms, guidance on how to have these conversations and implement tapers is scant. Furthermore, generalists report difficulty engaging patients about opioid safety, fearing the potential for fraught interactions that may strain the patient-provider relationship. Henry et al.’s study⁴ offers useful insights into a technique that may help prescribers increase patients’ motivation for opioid tapering: listening for clues that a patient already may be considering a change. Furthermore, the study revealed that generalists may be missing opportunities to follow-up with patients about potentially indicated LTOT reductions nearly half of the time. …