Opioid Tapering and the Patient-Provider Relationship

Excerpt

The surge in opioid prescribing in recent years has led to widely recognized harms and the declaration of a national opioid crisis in the USA. In response to this crisis, the Centers for Disease Control and Prevention (CDC) and the Department of Veterans Affairs/Department of Defense (VA/DoD) issued revised guidelines in 2016–2017.^{1, 2} For patients on long-term opioid therapy for chronic pain, these guidelines recommend tapering to lower doses or discontinuation when benefits do not clearly outweigh potential harms. Despite these guidelines, there is insufficient evidence to support any particular tapering approach, and, more concerning, there is a dearth of information on patient outcomes during and after tapering. A 2017 systematic review by Frank and colleagues found that many studies reported positive outcomes from opioid dose reductions, including improvements in pain severity, function, and quality of life.³ However, the quality of this body of evidence was determined to be very low. Moreover, for the studies that showed positive outcomes, the interventions tended to involve team-based, intensive support for patients—a model that is guideline-concordant, but not always easily implemented, especially in busy primary care settings. …