Deprescribing Opioids for Chronic, Non-Cancer Pain
This week we bring to you an opinion piece by one of our members, Kevin. He shares his passionate views on deprescribing, the current and previous research into this shift, hoping to promote change for those facing opioid challenges.
The Australian Government's Therapeutic Goods Administration Opioid Prescription Guidelines, updated 1-6-20, states as follows: "Opioids CAN be used as part of the management of chronic, non-cancer pain in circumstances where other pharmacological and non-pharmacological treatment strategies have not been effective, and the impact of poorly controlled pain has been considered."
Yet, in recent times, no doubt due to negative influences from the failed ‘War against Drugs’ in America, our own authorities have become unreasonably anti-opioid and fearful of addiction. The new buzzword is "deprescribing,” which means many chronic pain patients in Australia may be tapered off their life-saving and mobility-restoring pain killers against their will, despite using them successfully and as prescribed for many years.
WHY?
In my opinion, the new-age pain neuroscience theories postulating that "…Patients DO NOT experience increased pain or decreased function," when deprescribed is based on flawed science. This biased premise has poor quality ‘evidence-based’ studies, which have small sample sizes and rely on verbal anecdotes from selected participants. For example, this University of Sydney research project uses a tapering study with a very small sample size of ONLY 290 people, AND relies solely on people self-reporting and remembering their exact doses and dates of opioid reductions, without any reference to specific dosing regimens.
WHAT RESEARCH PROJECT YOU ASK?
The above study is being used, as part of an ongoing research project at the University of Sydney, as evidence that when opioids are de-prescribed, patients do not experience increased pain or decreased function. [!!] The ‘end-game’ is to arbitrarily decide whether to amend the TGA’s Opioid Prescribing Guidelines to either:
A. Support INVOLUNTARY deprescribing as the new gold standard across Australia.
B. Continue to follow the current Guidelines, which encourage VOLUNTARY deprescribing, if warranted i.e. a mutual agreement between the patient & Medical Professional initiating the process.
Forceful tapering or involuntary tapering is NOT acceptable, and has not worked in America, where hundreds of thousands of pain patients have been abandoned and harmed since their updated Opioid Prescribing Guidelines were introduced in 2016.
Unfortunately, people are already being involuntarily deprescribed in Australia, despite our current Guidelines not supporting this policy, and IF the Draft Guidelines from the University of Sydney Research project become our National Standard, then involuntary deprescribing will become accepted 'best practice’ or the new normal.
https://www.opioiddeprescribingguideline.com/development-group
‘Multidisciplinary’ Guideline Development Group
The above Link from the University of Sydney Research Project, indicates there is a multidisciplinary guideline development group, however, the reality is the ‘experts’ who are on the Advisory Group for the Draft Opioid Deprescribing Guidelines are addiction specialists, physiotherapists, RNs, pharmacists, de-prescribing experts (??), pain epidemiologists (??), systematic review experts (in what??), methodologists (??) GP's & just one consumer representative…who is also a Pharmacist.
NOTE: There is NOT one Pain Management Specialist represented on this Group!!
Does anyone see a disturbing pattern here?
How can any credible Research Group write guidelines on deprescribing opioids for vulnerable chronic pain patients without input from even one pain management professional?
Yet here we have three addiction medicine specialists having a disproportionate influence into the fate of opioid prescribing in Australia. The vast majority know nothing about chronic pain, or pain in general, as it is not part of their training or day to day clinical practice. Surely, they are busy dealing with those unfortunate people who suffer from psychological addiction issues, trauma and/or substance abuse disorders, not those chronic pain patients who have been using their opioids as prescribed for many years?
Is this an objective, ‘diverse’ and broadly representative advisory group?
High Quality Evidence for treating chronic non-cancer pain with opioids
In 2012, a group of distinguished pain clinicians from nine European countries got together to discuss the appropriate use of strong opioids, for chronic, non-cancer pain. These people are all at the top of their field and their conclusions and recommendations are drawn from vast clinical experience. That is ‘real world’ experience from caring for actual patients.
All agreed that while treating chronic, non-cancer pain with opioids was not without risk, some patients for whom all other therapies have failed can be SAFELY and effectively treated with opioids. These patients experience reduced pain and IMPROVED quality of life, where no other therapy delivers these benefits. Only a minority of patients will qualify, but opioids must not be denied these patients and guidelines should reflect such.
https://onlinelibrary.wiley.com/doi/full/10.1016/S1090-3801%2802%2900144-1
More Evidence, conclusively showing that Involuntary Deprescribing is harmful:
Please note, the Study below had a sample size of 113,000, NOT a population of 290, as used by the University of Sydney Research Group to draw conclusions from.
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