Involuntary Tapers: Legal, Ethical, and Clinical Concerns

On March 15, 2016, the Centers for Disease Control and Prevention released their guideline with recommendations for primary care clinicians who prescribe opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care. Although most of the recommendations were supported by weak or very weak evidence, Recommendation # 7 stated that “clinicians should optimize other therapies and work with patients to taper opioids to lower dosages or to taper and discontinue opioids” if the harms outweigh the benefits. At least a year after the release of the CDC guideline, several states have implemented dosage triggers, ceilings, and involuntary tapers, and some healthcare professionals have reportedly subjected their patients to involuntary tapers because they believed the CDC guideline required it. Consequently, this session will explore the ethical, legal, and clinical concerns and potential harms associated with the involuntary tapering of patients on long-term opioid therapy as a result of a state law, regulation, or out of fear of regulatory sanction by the healthcare provider.