The Centers for Disease Control and Prevention guideline for prescribing opioids for chronic pain released in March 2016 suggests that if “patients are found to be receiving high total daily dosages of opioids, clinicians should discuss their safety concerns with the patient [and] consider tapering to a safer dosage…”
All of us who prescribe opioids have had these discussions with patients. They are frequently fraught with hand-wringing and, all-too-often, a “steeling” for battle. We may have a general sense for what these discussions are like from the provider perspective, but what are they like for patients?
Joseph W. Frank, MD, MPH, and his colleagues conducted in-person, semi-structured interviews of 24 adult primary care patients to assess patient perspectives on opioid tapering ( Pain Med. 2016 Oct;17(10):1838-47 ). Patients were selected if they were: 1) currently on opioid medications without tapering; 2) currently tapering chronic opioid therapy (6 months or greater); and 3) discontinued chronic opioids therapy within the past 3 years.
Interestingly, patients had an overall low self-perceived risk of opioid overdose. Patients attributed reports of overdose to intent or risky behaviors. Patients rated the importance of treatment of current pain higher than the future potential risk of opioid use and had little faith in nonopioid pain management strategies. Patients reported fear of opioid withdrawal. They also reported the importance of social support and a healthy, trusting relationship with their provider for the facilitation of tapering. None of the patients reported switching providers who had recommended tapering. Patients who had tapered off opioids reported improved quality of life and a level of pain that was largely unchanged.
This work provides critical insight into the fears and reservations of patients facing the prospect of life on lower doses of opioids or life without them altogether. Addressing these fears directly may facilitate the discussions with patients when discussing the tapering of opioids.
Dr. Ebbert is professor of medicine, a general internist at the Mayo Clinic in Rochester, Minn., and a diplomate of the American Board of Addiction Medicine. The opinions expressed are those of the author and do not necessarily represent the views and opinions of the Mayo Clinic. The opinions expressed in this article should not be used to diagnose or treat any medical condition nor should they be used as a substitute for medical advice from a qualified, board-certified practicing clinician. Dr. Ebbert has no relevant financial disclosures about this article.
