Pain and Addiction Leaders Raise Alarm on Oregon Force Tapering Opioid Proposal

With the incredible dedication and efforts of multiple clinicians and patients advocated for those in pain, we a submitted a letter to Oregon HERC expressing deep concerns about Oregon’s proposal to force a vulnerable group of its citizens to taper off of opioids. Special thanks go out to Andrea Anderson, Dr. Stefan Kertesz, Kate Nicholson, and Dr. Beth Darnall who did most of the heavy lifting. We submitted the letter for today’s meeting, March 14, 2019 and released the following press release below. There are several versions of the letter:

The full letter can be found here: Oregon HERC 3-7-19

• We were required to trim that letter to 1000 words or less for the formal electronic submission. That letter can be found here: Oregon HERC 3-12-19
• Amara Moon, Wendy Sinclair, and Terri Lewis – with Andrea Anderson’s help – separately solicited support from a large number of Oregonians to submit a separate letter endorsing our letter which can be found here: Oregon Patient Signatures for HERC
• The press release (also copied below) can be found here: HERC Oregon Taper Press Release

Any credit I get for these letters and efforts is better given to the efforts of those who worked behind the scenes to bring this together. Additionally, I was humbled and awed by the outpouring of support from all the clinicians and leaders across the globe that signed on to this letter. You have my deep respect and appreciation.

Candidly, for those of you who know me, I try to avoid this topic of opioids. While I appreciate its importance, I am most focused on finding solutions for our public health problem of pain in this country and globally. However, when Andrea reached out to me and after speaking with Dr. Darnall, it became clear that there are times when people of good conscience cannot blindly allow bad policies to move forward unchallenged. Particularly when those policies target a vulnerable portion of our society who have the least means to fight back. I acknowledge and respect the State of Oregon’s authority to develop and enforce their own policies. But I cannot ignore state policies that propose to experiment on its population based on faulty or absent data, that is devoid of a plan for careful patient protections, and devoid of a plan to address the unintended consequences, and with no clear means of monitoring the impact. Not while I breathe and can protest. Our patients deserve better.

PRESS RELEASE

More than 100 of the foremost leaders in pain and addiction medicine, public health, and bioethics have raised critical concerns about a proposal in Oregon to deny opioid pain medications to a broad population of Medicaid patients.

On March 14, the Oregon Health Authority will vote on a proposal that would force Medicaid patients off opioid medications without their consent. The move, which would affect patients with more than 170 medical conditions, is an unprecedented attempt by a state government to arbitrarily deny opioid analgesic medications to broad classes of patients without regard for their individual conditions or if they have benefited from this class of medicine.

The expert letter, whose signatories included the current and several former presidents of professional medical associations and leaders of patient advocacy groups, characterized the policy as being scientifically unsound.

“(Oregon’s) broadly drawn policies for non-consensual forced opioid tapering lack evidence of benefit or safety and entail significant risks of harm,” the letter states.

The Centers for Disease Control, the Federation of State Medical Boards, and all other government or professional guidelines on opioid prescribing do not recommend forced tapering patients currently on opioid therapy, other than in situations where adverse events put the patient at risk. Non-consensual, forced opioid tapering risks destabilizing a patient’s physical and mental health in ways that have resulted in increased pain and suffering, disability, and even suicide.

Oregon’s proposal may also place physicians in the untenable position of having to choose between violating the ethics of their profession – to do no harm – or complying with the state-issued mandate.

Oregon proposes to replace opioid therapy with integrative and complementary treatments like yoga or counseling services. While the experts laud expanded coverage for such modalities, there is no firm evidence that these treatments offer sufficient pain care for patients with complex conditions. Most importantly, these treatments do not mitigate risks associated with opioid tapering.

The experts also warned Oregon Health Officials of the dangers of proceeding with this untested practice, especially as the state lacks the infrastructure to ensure that patients would be carefully monitored, supported, and cared for during or after any forced, non-consensual opioid taper.

The risks of involuntary tapering and the importance of facilitating access of medications to patients who need them have been highlighted by a growing chorus of health experts from many sides of the opioid debate, such as the American Medical Association and media outlets such as the New York Times, Reuter’s, Los Angeles Times, and Medpage. Oregon’s forced tapering proposals, in particular, have garnered attention as the most aggressive in the nation. The international watchdog organization, Human Rights Watch, highlighted Oregon’s forced tapering proposals in its recent report outlining human rights violations in pain care, as have the opinion pages of the New York Times and the Wall Street Journal.

The authors of the letter concluded: “(Oregon’s proposal) is a large-scale experiment on medically, psychologically, and economically vulnerable Oregonians, at a moment when Oregon has already seen a significant reduction in opioid prescribing and prescription opioid-related deaths.”