When Will Forced Tapering of Opioids End?
This article, in a slightly edited form, first appeared on Pain News Network on April 17, 2019.
“Larry” recently wrote to me asking for advice. He describes himself as “virtually crippled totally” after having his opioid medication cutback.
“I am being forced tapered and the PA I now have will not budge one inch on the weaning, as he calls it. I hate him. I have never had a more callous doctor in my life,” Larry wrote.
“What does one do in my situation? Blow my brains out? A[n] intentional overdose? I have two beautiful dogs that depend on me and a son who needs me. I have to stay here on planet Earth although I want out of here so bad I beg God to kill me every morning noon and night. It is my daily prayer.”
Unfortunately, Larry is only one of many patients who are struggling to be heard by their providers. Physicians are under government pressure to adhere to the CDC’s 2016 opioid prescribing guideline.
Although the CDC designed its guideline as voluntary, government agencies interpreted it as a mandate instead. The Drug Enforcement Administration has pursued doctors who prescribe a level of opioids that exceeds the guideline’s recommended daily limit of 90 MME (morphine milligram equivalent), even when no patients have been harmed.
According to Maia Szalavitz, writing for Tonic, Dr. Forest Tennant was one of the few physicians who still were willing to prescribe high-dose opioids for the sickest pain patients. The DEA raided his California office and home, allegedly because the agency had reason to believe some of his patients were selling their medication.
There simply was no evidence of that. But as a result of the raid, Dr. Tennant retired from clinical practice.
Szalavitz wrote that the raid “terrifies pain patients and their physicians, who fear that it could lead to de facto prohibition of opioid prescribing for chronic pain and even hamper end-of-life care.”
As Dr. James Patrick Murphy, a Kentucky-based pain and addiction specialist, told the Courier-Journal, “many well-intended doctors are unfairly arrested ‘all the time’ in the hunt for those who recklessly contribute to patients’ addictions and fatal overdoses.”
As of this writing, The American University Law Journal plans to publish an alarming article by Michael Barnes, JD, about the raids on America’s top physicians.
Although few physicians are incarcerated for prescribing high dosages of opioids, many of them are threatened with losing their licenses to practice medicine. Doctors and pharmacists told a POLITICO survey that they felt enormous pressure to limit their prescriptions for painkillers. Their fear of the consequences of noncompliance with the CDC guideline exceeded their responsibility to treat patients with severe pain.
Second Thoughts About CDC Guideline
On April 1, the attorneys general of 39 states and territories wrote a letter on behalf of the National Association of Attorneys General to Dr. Vanila Singh of the U.S. Department of Health and Human Services. The letter expressed concern with the draft report of the Pain Management Best Practices Inter-Agency Task Force, which recommends changes in the CDC guideline to end the forced tapering of patients.
The attorneys general said “it is incomprehensible that officials would consider moving away from key components of the CDC guideline.” Additionally, they expressed their hope that the report would be revised “to clearly state that there is no completely safe opioid dose.”
Yet on April 9, the Food and Drug Administration issued a medical alert warning doctors not to abruptly discontinue or rapidly taper patients on opioid medication, because it was causing “serious harm” to patients, including uncontrolled pain, psychological distress and suicides.
Now it seems the CDC may be moving in the same direction.
Dr. Daniel Alford, a Professor of Medicine at Boston University, wrote a letter to the CDC asking it to address the misapplication of its guideline with a “public clarification.” He was writing on behalf of Health Professionals for Patients in Pain, and 300 healthcare professionals signed his letter.
The CDC’s response, published on April 10, echoed the FDA’s statement. CDC Director Dr. Robert Redfield observed that the CDC guideline “offered no support for mandatory opioid dose reductions in patients with long-term pain.” He reinforced the fact that the guideline was voluntary and that doctors should use their knowledge of their patients to determine which dosages were appropriate for them.
Dr. Redfield wrote that “CDC is working diligently to evaluate the impact of the Guideline and clarify its recommendations to help reduce unintended harms.” And he agreed that “patients suffering from chronic pain deserve safe and effective pain management.”
STAT News points out that the overzealous enforcement of the CDC guideline was indeed causing patients harm. “Denying opioids to patients who have relied on them — sometimes for years — may cause some to turn to street drugs, thereby increasing their risk of overdose,” STAT warned.
According to The Washington Post, “Many patients have claimed that long-term use of the drugs is all that stands between them and unrelenting pain, and that they can take the medication without becoming dependent or addicted.”
The CDC and the FDA now admit the guideline has been misapplied and mainstream media outlets are beginning to pick up the story. The question is: Will the DEA stop pursuing doctors who treat pain patients with levels of opioids that exceed the guideline’s recommendations?
For Larry and other pain patients who have been forcibly tapered, the answer may be a matter of life and death.
Thank you for writing this as many need this information in a condensed version. It’s increasingly harder everyday myself, trying to just manage the day to day things, let alone my chronic intractable pain . I was force tapered in January and February and also put on something in the Suboxune Family. I ended up in the emergency room twice. I was never so afraid in my life. I hope things change back to us being properly treated because living this way is no way to live at all!
I will never believe that those involved in the development of the (well-intended), opioid guidelines could not foresee the (so-called) unintended consequences. Every policy maker knows that for every action there is an opposite and equal reaction. I fully believe they knew the guidelines would become weaponized by the DEA, insurers, local/state governments, pain clinics l(ooking to limit their liability), and so forth.
ALL of it could most certainly have been averted by simultaneously releasing a statement that directed the aforementioned NOT to miss apply, to not weaponize aka pervert into law, the guidelines. They could have made it abundantly clear the guidelines were meant ONLY as a guide for general practitioners who may not have the expertise, experience, or knowledge for treating long term pain aka chronic intractable pain, and chronic illnesses that cause unrelenting daily pain that lasts longer than what an acute illness or injury is expected to last.
At the very least the CDC could have (should have), made a public announcement as soon as they heard of the first weaponization of their guidelines. The fact that they did not only proves their initial intentions! They wanted all of this harm to take place. They wanted to see people in pain move to heroin. Nothing else makes any sense in my humble opinion.
The guidelines could have helped so many people without causing so much death and harm!!
I’m currently experiencing an unintended consequence. Or, should I say my boyfriend is experiencing it. He told his pain management doctor over a year ago that he was having much worse pain in his spine, hips, and ribs. She brushed him off and said it’s probably just worsening arthritis. He told her about other symptoms that do not coincide with arthritis such as a lack of energy, suddenly becoming mentally unclear/foggy, lack of appetite, inability to eat/feeling full even when he hadn’t had a bite to eat, being lethargic and other odd symptoms. But, time and again he was ignored and made to feel as if he was just trying to make excuses to get more opioids!!
Well, here we are over a year later and he’s just spent 13 days in the hospital and after surgery, bone biopsies, and multiple tests he has been diagnosed with Myeloma!!!! A rare blood/bone disease that MUST be caught as EARLY as possible in order to achieve the best long term outcome! His possibly shortened lifespan is on their hands!! The bigotry caused by the silence from the CDC, the opioid hysteria, the false narrative, and the weaponization of the guidelines have decreased his best chance!
How many more must suffer and DIE before we place as much value on the lives and treatment of chronic pain patients as we do for those suffering with the illness knowns as addiction!?!?
I could go on and on about this but thanks to my forced taper I have little energy to spare!
We must ALL call the CDC, FDA, DEA, Senate, Congress, Representatives, mainstream media, all news outlets, POTUS, and so forth and DEMAND clarification! We must all demand that the DEA end their reign of terror, stop their gun blazing raids and develop better, less traumatic tactics for taking down real pill mills and leave pain clinics that are legitimately treating patients with severe pain who require medically necessary high doses alone!
ONE SIZE DOES NOT FIT ALL!!
#AmericanGenocide #ChronicPain #OpioidHysteria #Spoonies #OpioidCrisis #PainCrisis #EndTheDrugWar
I too was accused of drug seeking behavior. After 4 weeks in the hospital, with 10/10 back pain. I was discharged with “anxiety attacks” and sent home. When a visiting nurse came over 2 days later, she took one look, called an ambulance and sent me to a different hospital. It was discovered that during that 4 weeks, an infection had systematically eaten away my bone, muscle, tendons, even hardware from a prior back surgery. I was near death and ended up spending 6 more months, & having 3 ten-hour surgeries to rebuild my spine. Why? Because I was accused of malingering, drug seeking and sent home in horrific pain. Because street addicts are dying from illicit drugs. Not those in pain, acute OR chronic. I guess we will go back to the days of the Civil War, give em a swig of whiskey and a leather belt to bite on. What is the use of technology and progress if we just go back through formulas that’s have failed. We are failing our patient’s in pain.
I am now seeing advertisements on our local TV stations that show people “shooting up” and implying that they are using opioids that came from a prescription or originally a legitimate source.
Next, they go on to say that “we should be looking at at alternatives to opioids for pain relief.” To use Tylenol or ibuprofen instead.
Obviously the people who are doing these ads have never had to deal with chronic pain on a daily basis or they would not be putting these up!
Get the DAMN DEA out of practicing medicine. The real opiate crisis is not a bottle of oxys it is illict fentanyl bought and sold on the streets but the DEA would rather go after Drs than drug cartels as Drs don’t shoot at LE agents.What the DEA has done to Drs and pain patients both chronic and acute is criminal. But I bet a DEA agent that is shot or otherwise injured while on the job gets whatever they need to ameliorate pain. Until a person experiences daily i tractable pain they have no idea what it does to not only the body but the mind as well. Addiction is a chronic and yes sometimes fatal disease just like cancer not a moral or even mental failing or illness. Why a shrink that has NEVER treated either acute or chronic pain has been given a platform to push an agenda to make anyone taking opioid meds an addict is in every sense blaming a medication for the disease of addiction that is utterly illogical and makes any or all medications that treat various chronic diseases the cause of those diseases. There shouldn’t be any 3rd party between a patient and their Dr whether the CDC the DEA HHS and Insurers. There is no opioid crisis except one manufactured by a handful of organizations such as PROP, rehabs, and those wanting to cash in on massive monies rehabs generate new MAT drugs for opioid addiction ie suboxone or bupe and Narcan or Naxalone to reverse an od. Problem is the majority of od’s have up to 6 different substances show up in the toxicology screens. Not sure how well Narcan will work on an od with substances other than opiates.The other problem is that most addicts will use whatever drug they can obtain if they can’t get their drug of choice. There is a vast difference between the disease of addiction and the many varied legitimate pain diseases. Tens of millions of people take opioid pain meds benzos and muscle relaxants daily safely and effectively because we follow the directions that come on a printed label affixed to every bottle legally prescribed by the Dr and legally dispensed by a licensed pharmacist. The big lie has been that by making street drugs illegal that somehow means drugs are controlled. The reality is there is no control whatsoever any six year old can buy sell and do any drug they buy from a street dealer. We are no closer today than we were since Nixon began the war on drugs to stopping illicit drug use and trillions of dollars spent. Fact prescriptions have been reduced yet ods continue to rise proof that diverted pain pills never played a part in ods. In the meantime suicides have risen imo many pain patients who cannot live with intractable pain every day of their lives. Massive suffering and harm has been caused by the CDC Guidelines and the groups that secretly met and madePUBLIC policy without input from those the Guidelines affected most Drs and their patients. One size does not fit all and any Dr trying that with any other drugs treating any other diseases would be guilty of malpractice. Pain patients are not addicts or malingering and have become victims of an overzealous war on drugs and comingled into those with the disease of addiction. The difference is that a pain patients meds last for the month. An addict can go through a 30 day supply in a matter of days. Pain patients seek only enough medication to alleviate their pain. An addict is seeking a high that a pain patient never gets because they have legitimate pain.
I hope something changes quickly or I am not going to make it ! Been on opioids since 2006 and have been slowly weened down now to 180 MME and I can’t do anything but basically lay in bed but it doesn’t make any difference how slow because if you are in pain you are in pain ! People need more than 90 MME’s. I was on 360 MME when reduction began and I know many are in the same boat I am in. How they came up with this low 90 MME level I don’t understand. You going to tell me someone weighing 120 lbs require the same as someone weighing 240 lbs. Doctors do need guidance on prescribing this stuff. Part of the answer is anyone needing these type drugs needs to go to a pain management doctor who is educated on the subject. Please someone do something quickly !
I have said this before and I’ll say it again, I have never had an issue with my Dr and being prescribed pain medication until the ACA took effect. We should never allow government involvement in our healthcare, and that is exactly what the ACA/Medicare for and singlepayer is. If that is ever implemented we are screwed, because it will be government bureaucrats making healthcare decisions for us in the name of money. You can fight an insurance company a lot easier than you can the government, plus you can always change you provider unlike government insurance. When government gives they can also take away.
After 6 back surgeries to try and stabilize be deteriorating spine with rods plates and torque screws, I’m in constant pain. I’m still able to walk but every step is a major effort. My balance is awful. I suffer from sagitial shift and proproception problems. The only time I get any peace is when I sleep. That does not come easy and in 2 hr increments. Yet, my insurance company is refusing to cover my oxys and I’m paying out of pocket and rationing them. One of my back surgeries was a triple thoracic fusion. The day after surgery, I’m lying in the hospital and the PA comes in. Stands at the foot of my bed and gives me a lecture about opioid addiction!!! I couldn’t even rollover or lie in my back!! I wanted to scream but I was not able. I just tried to reach my face with my hands to cry but couldn’t because of the I’ve lines and monitors. REALLY.
SOMETHING MUST BE DONE. OUR WUALITY OF LIFE and SANITY ARE AT STAkE
Dr. Webster, Thank you for this important post!!!
https://medium.com/@heatherzamm/social-engineering-leveraging-the-opioid-crisis-e9e99a9a4630
For 25 years I have had multiple conditions that cause me unrelenting pain. Been on & off meds but as my conditions deteriorate, I’ve been on them for many years. In fact, I was on a stable dosage of 180 MME between a long acting patch & immediate release for breakthrough pain FOR 12 YEARS!! Two years ago my dosage was cut in half in one visit… since then, my quality of life has evaporated.
Now that the long awaited backlash has finally started, I want to know how long it’s going to take for all of those of us caught up in this bs to get our pain properly treated again
I am very fortunate to have my PC physician stick by me when all this hit the fan. He was relentless about titratin g. I had taken 3 40s of Er Oxy and 6 7.5 325 norcos everyday for over 13 years. I never got addicted took as predcribed and was able to work full time
. Now i am on my way to a disability retirement from an $86,500 per year job! Im on ly 56 i had a lot more to do my husband is retired disab led and I am the main bread winner.our whole live, retirement plans, our very lives have been changed drastically because of ths. I now take 3 20s oxy a d 4 5.0 325 mg norco. I just cant keep up the pain is ba k i a big way i have pinched nerves that stay with me night and day now its so awful i cant clean my house or take care of my family the way i want to all because of this. So now all the travel plans are on hold i can barely make it through the day why have they do e this to us with no thought to the consequences. Its immoral, wrong and harmful on so many levels!!!!
“The CDC and the FDA now admit the guideline has been misapplied and mainstream media outlets are beginning to pick up the story.” Of course they are, now that their bad behavior is beginning to be picked up by the mainstream media. In the meantime, my pain management clinic claims that they are being audited by Medicare, so no one can have more than 50 MME per day, which I don’t believe. When I called Medicare to check on their policies, they hung up on me.
Cherry, one procedure helped me to bring my need for pain meds way, way down from what interfered with my wellbeing and a more manageable prescription daily quantity which I’ve had no problem attaining for 18 years (luck prevailed). There were known side effects of hormonal balance and the natural amount of dopamine produced by our own bodies. Finally, after three pain clinics, a somewhat embattled process, having gotten nowhere with the same SI shot, much patience and luck, FINALLY found another pain doctor who went admirably suggested RFA. I went from 4-500 mg to to 150 a day. This is an amount that I am more comfortable with. I do not see many references to the tiny quantities of benzodiazepines and/or relaxants. The clinics had, what I considered a useless and devastatingly intolerant stance of the 5mg of benzo that makes the difference as to sleep and just over zero sleep (whatever is the least amount and survive to tell of). This is a first entry in response in sometime. Sorry, carried away and veered from your circumstances to a general statement.. I hope this radio frequency ablation does as much for you as for me. Short mention that the unmitigated insomnia and allergy to the clinics prescription to replace Valium played a huge part in several falls and ultimately a busted thigh bone before I figured out the replacement was causing a bizarre reaction. Thanks for your patience. Nathan
Just as good, if not better than your 2014 article regarding patients having no say in this nightmare.
Thanks again!!
I was on these meds for 18 years! I also have been tapered, extremely fast. I ended up in ICU locally and had to be flown to a hospital in PA. Now I have lots of bills along with pain! it is impossible for me to focus, my Doctor said deal with it. but he had a head cold he couldn’t hardly function with! WTF!
I left a rambling reply elsewhere and did not see the edit feature to whittle down to more relevant material. At any rate –
I do not see many references to the tiny quantities of benzodiazepines and/or relaxants. The clinics had, what I considered a useless and devastatingly intolerant stance of the 5mg of benzo that makes the difference between a night’s sleep and just over zero sleep (whatever is the least amount and survive to tell of). A doctor gave me an immediate response time to a reinjury I’d carried the past 3&1/2 years using RFA. This was preceded by my waiting to jog my back in place again and several times within a year of SI injections. Minus a months time to give lidocaine test injections for the insurance company, the doctor at a different clinic went right into the regimen for relief of lower back pain via radio frequency ablation gain (I had RFA 15 years prior). This did wonders for me. However, over at the other office a R.N. prescribed by the book, I had little to no say, accept to refuse the meds other then MS Contin. This one other prescription included an average dose of 4mg Tizanipidine to replace Valium. Up until then the replacements for Valium written up by the RNs had sped my heart too much for comfort. With the unmitigated insomnia and severe allergy to the clinics replacement prescription for Valium had, in my estimation, put me in danger. This played a huge part in several falls and ultimately a busted thigh bone before I figured out the replacement was causing bizarre reactions. I haven’t had a reaction this extreme from a medication before. This has given me a dim, but I feel, accurate view of being extremely careful, I mean on the alert for what these people are doing when they jump into a persons file, believing all the answers are in the trusty manual handed out with their newfound place in the world….smack between a doctor and her/his patients. Thanks for your patience. Nathan
this is really an good and informative article thanks for telling us about Opioids.
I have had five operations on my neck, and the pain has become so overwhelming, that I only had three choices.
One, suicide.
Two, illegal drugs.
Three, leave the country.
I now live overseas. My wife and I have given up everything we had, house, cars, friends and family,,,,,,,and we consider ourselves very fortunate!!!
Those of us who are in mind numbing pain, can’t fight the whole system, and most people only have the first two choices.
I feel so incredibly sad for the hundreds of thousands of chronic pain patients, who must live in such a heartless, hopeless place.
I wish I could somehow help you all.
I hope you can all make it, until sanity returns. Stan