The Oregon Health Authority has approved new guidelines for lowering opioid use for people with long-term health conditions which could include chronic back pain or arthritis. The guidelines, which received unanimous approval from OHA task force members, have drawn concern from patients in the state who use opioids to treat chronic pain conditions.
“For people on high doses the answer often is: the risks outweigh the benefits,” said Jim Shames, health officer for Jackson County. Shames is one of a group of doctors on an OHA task force who developed the voluntary guidelines.
The new opioid tapering guidelines are one piece of a larger strategy in Oregon created in 2015 known as the Opioid Initiative geared towards reducing the use of powerful pain killers. The newly approved tapering guidelines follow others tailored towards acute pain, dentists and pregnant women.
The new tapering guidelines suggest a range of conditions when opioids should be reduced. They include when patients start abusing their prescriptions, when they no longer experience reductions in pain, or when they’ve experienced an overdose involving opioids, among other circumstances.
However, the guidelines specify that not all patients need to be tapered off opioids and they emphasize the importance of individual buy-in from both patients and their doctors.
“The goal of the Oregon Opioid Tapering Guidelines is to reduce harms to patients associated with opioid use and promote patient-centered care,” reads the most recent draft of the guidelines.
But, despite those caveats, some patients with chronic pain conditions are worried the new suggestions will cut off access to drugs.
“I don’t think it’s an appropriate reason to taper somebody when they are functioning well and benefiting from a medication that helps them manage incurable pain,” said Wendy Sinclair, co-founder of the Oregon Pain Action Group. Sinclair suffers from chronic pain from a broken back.
Her group’s Facebook page includes several hundred members who, she says, also suffer from chronic pain conditions.
The current climate about opioids has caused the pendulum to swing too far towards eliminating the pain-management drugs all together, according to Sinclair. She says as a result, patients like her are being wrongly stigmatized.
“We are guilty until proven innocent,” she said. “Even though we are non-addicted chronic pain patients, we’re being lumped together with addicts.”
Jim Shames in Jackson County says these new guidelines are part of an important correction after decades of misleading information about the safety of opioids.
At the end of Friday’s meeting, task force members discussed disseminating the new voluntary guidelines to providers around the state.
“I think we owe it to everybody to have a frank conversation, explain what’s going on, offer the possibility of different ways, better ways, more functional ways of dealing with their pain,” Shames said.
