Addiction psychiatrist questions involuntary tapering of opioids


A renowned author and addiction psychiatrist says the efforts of the Department of Veterans Affairs and other institutions across the country to taper people off opioids without their consent is “an outrage.”

“To take a patient who’s doing well off of medication abruptly and without their permission is not unfair. I actually think it’s malpractice,” Dr. Sally Satel said. “I think it is an outrage when you have a person who’s doing well on a dose of medication, highly functional and their pain is under good control. This is what you want. This is the clinical outcome.”

Dr. Satel is a resident scholar at the American Enterprise Institute and a lecturer at Yale University. She’s a vocal opponent of the involuntary tapering of controlled opioids.

“It shouldn’t be done without their permission,” she said. “Without the patient’s consent, the results are often disasterous.”

Mountain Home VA Medical Center is prescribing half as many opioids as it did in 2012, according to recently released federal data. Since December 2016, several veterans have voiced their frustration over what they’ve said is a mandate to taper their pain medications.

Dr. Satel says many institutions have misinterpreted the Centers for Disease Control’s pain management guidelines as mandates rather than recommendations.

“It doesn’t say anything about taking people off their medications if they don’t want to go off of it,” Dr. Satel said. “Of course, it’s frustrating, especially when it’s misinterpreted in the direction of poor patient care. It’s very frustrating.”

For decades, VA and other doctors have prescribed pain medications because they thought, at the time, that’s what patients needed. However, in recent years, they changed their approach when new research found opioids can be dangerous and ineffective.

“I understand their fear, their anxiety and their anger, but I want them to understand this is driven by our concern for their safety,” Mountain Home VA Opiate Safety Initiative Chairman Dr. Martin Eason said in December 2016.

Most recently, Mountain Home VA Chief of Staff Dr. David Hecht said the facility is proud of its 49% decrease in opioid prescriptions since 2012. He added, doctors consider every patient’s need on a case-by-case basis and taper veterans off opioids in a safe way.

“Many veterans have really understood and bought into it and it has helped us,” Dr. Hecht said. “Any time we reduce these medications, we want to reduce them in a safe environment.”

The VA maintains it has taken patients off opioids gradually and given veterans the opportunity to appeal their tapering decisions. The agency adds while opioids may help with short-term pain, they are not approved to treat chronic pain in non-cancer patients. Mountain Home is now encouraging veterans to try safer and more effective alternatives.

As we reported earlier this month, VA representatives plan to discuss preliminary data that show a link between opioid discontinuation and suicides at an upcoming summit. Dr. Satel has authored several published works alongside one of those speakers.

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