Attitudes Toward a Pre-authorized Concealed Opioid Taper: A Qualitative Analysis of Patient and Clinician Perspectives

Abstract

Standard opioid tapers tend to be associated with increased patient anxiety and higher pain ratings. Pre-authorized concealed opioid reductions may minimize expectations such as fear of increased pain due to the reduction of opioids and, prolong analgesic benefits in experimental settings. We recently observed that patients and clinicians are open to concealed opioid tapering. However, little is known about the “why” behind their attitudes. Based on this lack of data, we analyzed qualitative responses to survey questions on patients' and clinicians' acceptance of a concealed opioid reduction for chronic pain. Seventy-four patients with a history of high dose opioid therapy and 49 clinicians completed a web-based questionnaire with open-ended questions examining responses to two hypothetical clinical trials comparing a concealed opioid reduction pre-authorized by patients vs. standard tapering. We used content analysis based on qualitative descriptive methodology to analyze comments from the patients and clinicians. Five themes were identified: informed consent; anxiety; safety; support; and ignorance is bliss, or not. These themes highlight the overall positive attitudes toward concealed opioid tapers. Our findings reinforce the importance of patient-centered care and are expected to inform the design of clinical trials from both the patient and clinician perspective. This qualitative study presents patients' and clinicians' attitudes toward hypothetical scenarios for a trial of pre-authorized reduction of opioids. The findings indicate positive attitudes and the relevance of engaging patients with effective decision-making processes.

Trajectories of prescription opioid tapering in patients with chronic non-cancer pain: a retrospective cohort study, 2015–2020

“…It is still unknown whether those tapers were conducted at a faster rate for justifiable reasons, such as patient preference to reduce the duration of a taper for reasons of patient discomfort, or clinician concerns about opioid use disorder. 37 It is possible that faster tapers were in response to the recent implementation of a number of national and state-based opioid-related interventions to curb opioid prescribing in Australia. 38–39 After the publication of 2016 Centers for Disease Control and Prevention Guideline for Prescribing Opioids for Chronic Pain in the United States, there have been reports of inflexible application of dosage and duration thresholds, abrupt cessation of opioids, and clinician dismissal of patient care.…”

The desire for side-effect information in pain treatment: an experimental analysis of contextual and individual difference factors

“…16,41 This might be accomplished by informing patients about nocebo effects (termed nocebo education) and asking for their preference on receiving certain side-effect information. 5,9,31 Little is known, however, about the desire for side-effect information. Surveys find that, although most individuals frequently desire all potential side-effect information, there can be variability in this desire.…”