For health care professionals, opioid addiction is a complex problem that requires careful physician monitoring because of the dangerous side effects. The Federal government has issued safety warnings and guidance for physicians to address the opioid crisis. Earlier this year, the U.S. Food and Drug Administration issued a warning to physicians and health care professionals not to abruptly discontinue opioids in patients who are dependent. The FDA also required label changes to guide prescribers on gradual, individualized tapering.
Opioid addiction carries serious risks, including increased pain, withdrawal and psychological symptoms, changes in mood, thoughts of suicide, and death. Examples of common opioids include codeine, fentanyl, hydrocodone, hydromorphone, morphine, oxycodone, and oxymorphone.
When a provider and patient have agreed to taper the dose of opioid analgesic, factors such as the dose of the drug, the duration of treatment, the type of pain being treated, and the physical and psychological attributes of the patient must be considered.
No standard opioid tapering schedule exists that is suitable for all patients. Providers are encouraged to create a patient-specific plan to gradually taper the dose of the opioid and ensure ongoing monitoring and support, as needed, to avoid serious withdrawal symptoms, worsening of the patient’s pain, or psychological distress.
Last October, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, known as the “SUPPORT Act,” was signed into law. The law outlines national strategies intended to help address opioid misuse.
As part of the SUPPORT Act, Section 6065 requires CMS to send a notification to prescribers of opioids with prescription patterns identified as “outliers” compared to their peers, and to encourage them to reference established opioid prescribing guidelines. Notifications must include information on opioid prescribing guidelines, such as the Centers for Disease Control and Prevention Guidelines for Prescribing Opioids for Chronic Pain, and/or guidelines developed by physician organizations. For “persistent outlier prescribers,” a separate requirement identifies additional outreach and training to address potential remedies.
Attend the virtual listening session Monday
“We’re looking for your insights on how CMS can best meet these SUPPORT Act requirements,” said Dr. David Nilasena, Chief Medical Officer for CMS Dallas Regional Office. “We understand that CMS must be very thoughtful and respectful about how we communicate with providers around these issues, and we need your help and expertise to meet the requirements.”
Dr. Nilasena is one of 16 presenters who will share their expertise at PMI's National Conference for Medical Office Professionals in December. Dr. Carlos Francisco Tirado, M.D., M.P.H, F.A.B.A.M. a Psychiatrist, Board Certified in General and Addiction Medicine will also present on insights, best practices, and resources for provider teams to combat the opioid crisis. View Day 2 conference sessions for more information about these presentations.
Opioid Addiction and the SUPPORT Act background references and resources:
- SUPPORT Act: https://www.congress.gov/bill/115th-congress/house-bill/6/text - click the link to section 6065, which is the subject of this session
- CDC Guideline for Prescribing Opioids for Chronic Pain – U.S. 2016: https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fmmwr%2Fvolumes%2F65%2Frr%2Frr6501e1er.htm
- CDC Advisory: https://www.cdc.gov/media/releases/2019/s0424-advises-misapplication-guideline-prescribing-opioids.html
- FDA Safety Alert: https://www.fda.gov/drugs/drug-safety-and-availability/fda-identifies-harm-reported-sudden-discontinuation-opioid-pain-medicines-and-requires-label-changes