The Politico website (of all places) recently published a long and informative discussion about the unintended consequences of various measures to restrict access to prescription opioids. It was another piece on the site that caught my eye, however. This one addressed a subject I rarely see explored in the media: How to successfully taper off after long term use of opioid pain meds.

Many pain patients don’t want to quit taking opioids, but others do, for a variety of reasons. That leads to the question: what’s the best way to end their dependence?

Here’s a summary of suggestions from the article:

  1. Go slow, be willing to ask for help. “This is not a race, it’s a journey,” says one former user.
  2. Explore all your options for non-opioid pain treatment. New ones appear frequently.
  3. Develop a strong support system. Don’t try to do it all by your lonesome.
  4. Take care of your emotional and mental health needs. Depression and anxiety can be a problem.

Is this beginning to sound familiar? It will to addiction clinicians. It’s what they routinely advice their patients.

Of course patients have been successfully tapering off opioids for as long as I’ve been in the field (we’re talking about non-cancer pain, of course). But I’ve seen patients succeed even in severe cases.

And now we have research that suggests that this may be a good idea. Long-term opioid use may lead to hyperalgesia, or increased pain sensitivity. Just the other day, this popped up on a recent search:

Stopping long-term opioid therapy has no effect on pain

It’s important to remember that chronic pain is now considered a disorder in its own right, separate from the acute pain that may have preceded it.  It’s often accompanied by depression and anxiety, and that alone may make it worthy of specialized treatment. Unfortunately, most healthcare professionals lack the training to provide such treatment, or simply aren’t interested. They often fail to refer out when needed.

I can’t help seeing this as a correctable flaw in our healthcare system. Here we are passing laws to force practitioners to restrict access, yet don’t provide the comprehensive help that long-term opioid users require to make the transition. The answer isn’t to back off and make opioids widely available again (although some Pharma firms would dearly love to see that). It’s to make sure patients get the services and support they need.

Not everybody wants to remain dependent on pain medication. But at present, we offer few if any alternatives to a kind of cold turkey. No wonder so many fail.


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