- Federal officials are warning physicians they shouldn’t cut off patients from opioids too quickly.
- To fight the opioid epidemic, physicians have been advised to cut down on opioid prescriptions.
- But that may mean some patients were cut off “cold turkey,” causing withdrawal symptoms.
- In other cases, patients with chronic pain may be advised to continue to take opioids.
With the opioid epidemic claiming 130 lives every day, public health experts and medical officials have pushed to decrease the amount of opioids being prescribed.
But now federal officials are warning physicians take patients off opioids too quickly.
The Department of Health and Human Services (HHS) revisited its opioid guidelines last week, warning doctors that taking patients off opioids too quickly could do more harm than good.
The guidelines, which focus on the benefits of gradually and safely weaning people off the drugs, are a response to growing concerns about the ongoing opioid crisis in the United States and how the drugs are prescribed.
As the medical community became increasingly aware of the epidemic — which killed nearly 218,000 people between 1999 and 2017 — many clinicians took their patients off the drugs cold turkey or tapered them off far too quickly, putting them in harm’s way.
Now, the government hopes the new guidelines will ensure patients are safely and gradually tapered off the drugs, and that they get the compassionate care they need to make a successful comeback.
“In efforts to curb the current wave of the opioid crisis, we need to reflect as an industry and introduce education and protocols to encourage judicious and safe prescribing of medications to alleviate pain. We need to avoid creating another healthcare crisis where patients with pain are left to fend for themselves,” said Dr. Sandeep Kapoor, an addiction specialist and the director of the Screening, Brief Intervention, and Referral to Treatment program at Northwell Health.
The guidelines should be implemented in a patient- and clinician-centric manner to maintain a balance of safety, Kapoor says, adding that this new approach should be well thought out and customized, rather than a one-size-fits-all, cookie-cutter approach.
The opioid epidemic started back in the 1990s when pharmaceutical companies assured healthcare providers that the pain-relieving drugs were safe and effective.
With this in mind, clinicians began to prescribe opioids to patients. Over time, those prescribing rates soared. In 2012, the United States saw more than 255 million opioid prescriptions.
Soon, people were misusing the drugs and quickly developing addictions. A crisis was growing.
In 2016, the Centers for Disease Control and Prevention (CDC) published prescribing recommendations encouraging providers to consider alternative therapies first and to lower the dosage and duration of opioids.
Many clinicians immediately took patients off the drugs and stopped prescribing them altogether. Within the year, opioid prescribing dropped by about 10 percent, according to a report from IQVIA’s Institute for Human Data Science.
However, this meant some people who actually needed the drugs for chronic pain or had become physically dependent on them were cut off immediately, which harmed them.
“Since the CDC Guidelines for Prescribing Opioids for Chronic pain was released in 2016, many regulators have been using a one-size-fits-all approach evaluating and enforcing pain care and opioid use. This, unfortunately, has led to many healthcare providers lowering these medications too quickly and causing patients to experience withdrawal or turn to illegal sources to obtain these medications,” said Yili Huang, DO, the director of the pain management center at Phelps Hospital in Sleepy Hollow, New York.
In 2017, there were more than 47,000 fatal overdoses across the country, and the HHS declared the opioid crisis a public health emergency.
The CDC followed up on its recommendations earlier this year, noting that many providers had misapplied the guidelines and reduced opioid prescriptions too aggressively — which brings us to the new guidelines the HHS published Thursday.
The greatest risk of tapering someone off opioids too rapidly is withdrawal.
According to the HHS, sudden discontinuation of opioids can cause those who have a dependence on the drugs to feel more pain and experience severe psychological distress and thoughts of suicide.
Anxiety, insomnia, irritability, muscle aches, sweating, and diarrhea are common withdrawal symptoms as well.
“The best way to describe opioid withdrawal symptoms is a very bad flu,” Huang said.
These withdrawal symptoms can cause patients to illegally seek out the drugs, according to the guidelines.
That can include dangerously strong additives, like fentanyl, Huang adds. And if someone stops taking opioids then goes back to the original dose they were taking, they put themselves at risk for an overdose.
When patients are appropriately tapered off the drugs, the risk for withdrawal is exponentially lower, and patients have a greater chance of making a full recovery.
The guidelines stress that each patient should have their own custom tapering plan that’s in line with their goals and concerns.
“The ultimate goal is more than just to lower opioid use. It is to improve the patient’s health and function. To maximize the chance of success, the patient’s medical, functional, pain, and psychological needs should be addressed by a team of specialized providers,” Huang said.
For example, the longer someone’s been taking opioids (i.e., for a year or more), the longer their taper will take, the HHS notes.
On the other hand, some patients can tolerate a faster taper, especially those who’ve been using opioids for weeks or months rather than years.
If a patient’s being tapered off and begins to experience withdrawal, it’s best to pause and restart when the patient is ready.
Lastly, some patients who experience chronic pain could very well benefit from opioids at an appropriate dose, many health experts believe.
“Opioid utilization is warranted for many, and we should not lose sight of this. When considering reduction and/or halting of opioids, consequences that can lead to increased risk of morbidity/mortality need to be closely monitored and planned for,” Kapoor said.
The opioid epidemic is still very much alive, but Huang says the new guidelines are a great step in the right direction.
The Department of Health and Human Services (HHS) released new opioid guidelines last week, warning doctors that taking patients off opioids too quickly could do more harm than good.
The guidelines focus on the benefits of gradually and safely weaning people off the drugs. The government hopes they’ll help lower patients’ risks for withdrawal and overdose.
The guidelines aren’t a one-size-fits-all approach, health experts say. Each patient should be tapered off opioids in a manner that prioritizes their own goals and concerns.