This week we published in Pain Medicine a letter opposing community-based forced prescription opioid tapering in patients taking long-term prescription opioids. The letter expresses deep concern over a lack of patient protections and evidence to support reductive policies that center on forced opioid tapering, particularly rapidly and to extremely low doses.

Indeed, across the U.S. and in other countries, certain prescription policies have moved ahead of the science. Opioid prescribing limitations are being enacted without having clear evidence for how to implement tapers compassionately and safely. In an effort to rapidly reduce opioid doses — in the name of reducing patient risks — new risks are being conferred, some with equally grave consequences. This reactionary approach reductively focuses on opioid dose reduction and misses the point: we are delivering medical care to patients, and patient safety and wellbeing should be paramount. That medical decision-making should be made by the physician or clinician who is responsible for the patient’s care and should be patient-centered, taking into account their individual circumstances, comorbidities, and history.

Aggressive opioid tapering undermines patient care and outcomes, and increases patient distress. The methods by which a taper is conducted matters greatly, requires careful considerations for patient protections, and should be supported by solid evidence in the patient population and setting that the proposed taper will occur. Such policies may involve insurance companies, pharmacies, healthcare organizations, and state and federal agencies.

Our letter was signed by roughly 130 pain expert signatories from the US, Canada, the UK, and Australia, and was submitted to the U.S. Department of Health and Human Services (HHS).

Originally published at on December 1, 2018.