A common perception about prescription opioids is that less is better. Health risks exist with prescription opioids. While true, for people taking daily prescription opioids long term, reducing their opioid doses is equally fraught with health risks. Thus, in the rush to help patients take less medication we’ve seen some tragic consequences emerge including deaths. In the past few years a burgeoning literature has described the risks associated with opioid dose changes, particularly rapid dose changes and forced dose reductions.
The best way to care for patients is to treat them as the individuals they are – accounting for each person’s unique medical circumstances, needs, and response to medications. Patients who benefit from medications should not be forced to reduce or stop the medication because of “average health risks”.
Patients who want to reduce their opioid doses should be given a supportive and safe pathway to do so. With the EMPOWER study, we are applying a patient-centered approach that gives each person ample control in the process of gradual opioid reduction. Tapering is voluntary. During the taper, patients can control their taper pace, pause their taper, or even stop their taper if they wish. EMPOWER also allows opioid dose increases during the 12-month study period. EMPOWER is also studying two evidenced-based behavioral treatments within the context of voluntary opioid reduction. We are testing whether these behavioral treatments can help reduce chronic pain and help people achieve their goals.
EMPOWER was designed in partnership with patients. Since 2018 I’ve had the honor of leading this 4-state study that is funded by the Patient-Centered Outcomes Research Institute. To learn more about EMPOWER and our patient-centered work, I invite you to read this recent feature.