HHS is publishing information to educate clinicians on how to appropriately taper long-term opioid users off their medications, saying it wants to clarify 'misinterpretations' about previous prescribing guidelines that led some providers to abruptly stop opioid treatments.
The agency released a guide Thursday to advise providers on issues that could arise when transitioning chronic pain patients off of opioids as a long-term therapy.
The new HHS guide recommends tapering off opioids at a rate "slow enough to minimize opioid withdrawal symptoms and signs," and moving more slowly the longer patients have been using opioids.
Common tapers range from reducing opioids dosage between 5% and 20% every four weeks, but HHS recommends reducing dosage by 10% per month or slower for patients who have used opioids for more than a year.
HHS' assistant secretary for health Dr. Brett Giroir urged clinicians to collaborate with patients on deciding how fast they reduce or stop their opioid therapies.
"We know that it is critical that clinicians manage acute and chronic pain in an individualized, patient-centered way," Giroir said.
There have been numerous reports of individuals being abruptly cut off their medication regimen after the Centers of Disease Control and Prevention's Guideline for Prescribing Opioids for Chronic Pain in 2016, according to Giroir.
The CDC guidelines recommended clinicians prescribe opioids only after exhausting other pain therapies, prescribe the lowest effective dosage, evaluate patients within 1 to 4 weeks of starting opioid therapy for chronic pain, and taper or discontinue opioids if the harms outweigh the benefits.
Many experts cite the release of the CDC guidelines with a stark decline in opioid prescriptions, which fell from a record high of 255 million written in 2012 to more than 191 million by 2017, according to the most current CDC figures.
But the guidelines have come under much scrutiny by some clinicians and pain management advocates who felt the recommendations gave physicians license to immediately cut patients off opioid medications, even though the CDC warned against taking that step.
The authors of the CDC guidelines wrote a paper published in June in the New England Journal of Medicine where they acknowledged some healthcare providers had "went beyond" the recommendations, leading to policies that encouraged, "hard limits and abrupt tapering of drug dosages."
"Unfortunately, some policies and practices purportedly derived from the guideline have in fact been inconsistent with, and often go beyond, its recommendations," the paper said.
Health experts warn lowering the dosage or discontinuing and opioid regimen too quickly can increase patients' risk of experiencing severe physical withdrawal symptoms, psychological distress, or raise their likelihood of them switching to illegal narcotics like heroin and fentanyl.
"Clearly, we believe that there has been misinterpretation of the [CDC] guidelines, which were very clear," Giroir said. "People have inappropriately misinterpreted cautionary dosage thresholds as mandates for dose reduction."
