“Those Conversations in My Experience Don’t Go Well”: A Qualitative Study of Primary Care Provider Experiences Tapering Long-term Opioid Medications

Abstract

While discussing and implementing opioid tapering present significant challenges, primary care providers described key facilitators. These findings suggest a need to develop and test the effectiveness of resources to support patient-centered opioid tapering and locally developed policies to support and standardize providers' approaches to opioid prescribing.

Association Between Opioid Dose Variability and Opioid Overdose Among Adults Prescribed Long-term Opioid Therapy

“…Although there could be numerous reasons why patients are exposed to dose variability, one reason is an attempt to taper or discontinue opioid therapy. An attempted dose reduction may be associated with opioid withdrawal or increased short-term pain, 37 , 38 , 39 prompting patients to request a subsequent dose increase. Because of loss of tolerance after a period of reduced opioid exposure, 40 , 41 , 42 such dose adjustments may be associated with increased risk of opioid overdose.…”

The Pain Divide: a cross-sectional analysis of chronic pain prevalence, pain intensity and opioid utilisation in England

“…31 While this is helpful in some instances, it is often difficult to ascertain, in a clinical setting, if opioid analgesics continue to provide ongoing pain relief; patients using opioids are also often reluctant to reduce or stop their opioid medication. 32 33 Studies also show that opioid discontinuation is associated with reducing pain scores; opioid-induced hyperalgesia also reduces on opioid cessation, which can further reduce levels of pain. 34 Given our findings, more needs to be done—at a national level—to support prescribers to manage people who have chronic pain, without the need to initiate opioid analgesics.…”

Doctor-Patient Trust Among Chronic Pain Patients on Chronic Opioid Therapy after Opioid Risk Reduction Initiatives: A Survey

“…The high levels of perceived trust are surprising considering that most of the literature about the doctor-patient relationship and opioids is about difficulties in communication and lack of trust. [32][33][34][35][36][37][38][39][40] Possibly, COT patients who participate in focus groups and other studies of the doctor-patient relationship around opioid prescribing for chronic pain are those who are most dissatisfied with their care [32][33][34][35] and that doctors tend to remember and report interactions with the minority of COT patients where conflict and impaired doctor-patient trust are most prominent. 32,36 -39 If this were true, the minority of doctor-patient relationships with impaired trust could lead to overly broad generalizations regarding the difficulties of reducing opioid dose and implementing closer monitoring with more typical COT patients.…”

“…2,6 They are consistent with more general studies of patients that report trust in their primary care doctors is high. 41,42 We believe these results are both counterintuitive, given the published literature on the topic of opioid prescribing and the doctor-patient relationship [32][33][34][35][36][37][38][39][40] and reassuring because they demonstrate generally high levels of patient perceptions of trust in their doctor and only modestly lower levels of trust related to opioid management among COT patients after implementation of opioid risk reduction initiatives. This suggests that it may be possible to implement opioid risk reduction initiatives while sustaining high levels of doctor-patient trust for most COT patients.…”