Thursday , October 21 2021

Forcing a patient to take opioid analgesics, and you can harm people: experts – National


Forcing patients with opioid analgesics can sometimes do more harm than good, international experts warn in an open letter to health officials.

The letter, published in the journal Pain Medicine, outlines the risks associated with the forced reduction of dependency drugs and urges policymakers in the US to develop guidelines that are not "aggressive and unrealistic."

Nearly 18 million Americans are long-term opiate users because of chronic pain. In the wake of an opiate addiction crisis that has claimed thousands of lives, health regulators and the medical community have reduced the number of opioid pills prescribed to patients.

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The US Centers for Disease Control and Prevention advocates the gradual reduction and, in some cases, discontinuation of opioids in patients who use them as long-term therapy for chronic pain.

However, in their letter, Beth Darnall of Stanford University, California, and coauthors say that the consumption of opioids requiring "aggressive" dose reductions over a defined period, even when that period is prolonged, can be problematic.

They call for "compassionate opioid-reduction systems" in carefully selected patients with close monitoring and realistic goals. They also call it "patient advisory councils." . . to ensure that patient-centered systems are developed and patient rights are protected. "

"The assumption that the forced reduction of opiates is reliably beneficial is not supported by evidence, and clinical experience suggests significant harm," said Ajay Manhapra of Yale University, co-author of the letter.

For example, the letter notes, rapid forced reduction can destabilize patients, lead to aggravation of pain, precipitate severe opiate withdrawal symptoms, and cause profound loss of function.

Some patients may seek relief from the supply of illicit and more dangerous opioids, while others risk becoming "extremely suicidal," the article adds.

"With the tapeworm opiates culture, pain experts are killing," Manhapra said. "Our clinical experience is that with the rapid reduction, health costs increase due to the overuse of other expensive services such as emergency rooms and spinal specialists."

"Whether it's a quick or a slow reduction, the big question is – well, what do you do after that?" Richard Blondell, vice president of addiction medicine at the University of Buffalo in New York, who was not in between. the authors of the letter.

"What we really need is better science, no more politics. . . In my experience, when you have global recommendations based on expert opinions and try to apply them to individual patients in individual clinics, there is a lot that gets lost in translation. "

READ MORE: 2,066 Canadians died of opioid overdose in the first half of 2018

The letter asks the US Department of Health and Human Services to consider patient data and to include pain specialists in developing opiate reduction guidelines.

Manhapra believes that the burden remains on policymakers.

"It looks like the storm blew from one side from 1980 to 2016 and is now blowing strong on the other side while we (doctors) stagger in the same place trying to care for our patients who are suffering," he said.

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