Physician Partners of America offers opioid alternatives and careful dosage reductions –
Many chronic pain patients come to interventional pain management specialists, including Physician Partners of America doctors, while taking opioid medication. PPOA, like many other practices, sets a goal of tapering them off these highly addictive medications to avoid opioid withdrawal symptoms.
Now the U.S. Food and Drug Administration is officially cautioning doctors to go easy when it comes to reducing dosages. Opioid withdrawal symptoms, recurrence of pain and mental distress has led some patients to turn to street drugs. Tragically, some commit suicide.
Says the FDA: “Rapid discontinuation can result in uncontrolled pain or withdrawal symptoms. In turn, these symptoms can lead patients to seek other sources of opioid pain medicines, which may be confused with drug-seeking for abuse.”
In a recent survey of 6,000 pain patients by the Pain News Network, more than 80 percent said they had been taken off opioids or had their dose reduced. Almost half said they had considered committing suicide because their pain was being poorly treated. Others turned to other substances – legal and illegal – for pain relief.
According to the survey:
- 26% turned to medical marijuana
- 20% used alcohol to quell pain
- 20% used the poorly regulated Asian herb kratom11% got opioid medication from friends, family members, or the black market
- 11% got opioid medication from friends, family members, or the black market
- 4% used illegal drugs such as heroin and illicit fentanyl
PPOA has long taken the recommended go-slow approach. Its specialists may use special medications to prevent symptoms if needed.
“There are several tools at the disposal of the physicians to mitigate opiate withdrawal symptoms,” says Abraham Rivera, M.D., PPOA Chief Medical Officer. “A new drug called Lucemyra can block most withdrawal symptoms in patients with abrupt opiate cessation. Most commonly, the opiates are slowly decreased no more than 20 percent per week until the doses are minimal.”
To prevent opioid withdrawal, PPOA strives to avoid prescribing opioids in the first place. The company advocates interventional pain management treatments instead, such as nerve blocks, injections, neuromodulation, intrathecal medication pumps and laser spine procedures. These treat the pain at its source.
Careful medication management is part of treatment plans for new patients who have come to rely on opioids as a daily pain management tool.
“At PPOA we use opiates as a means to an end, not as an end by itself,” says Dr. Rivera.
Reducing a patient’s medication, a process called titration, can catch some new patients by surprise. They may be used to getting their prescriptions filled time after time by previous providers. But as laws tighten the grip on prescribing, and the effects of the opioid crisis escalate, patients will be hard-pressed to find any ethical provider who offers unfettered access to addictive painkillers.
The FDA did not give details on specific patient harm cases but said in a statement that it was tracking them. The regulatory agency indicated it will change warning labels on prescription opioids to guide physicians on safe reduction rates.
The agency also did not recommend a specific tapering schedule to prevent opioid withdrawal symptoms. Instead it recommends that physicians take into account the length of time that a patient has been using additive analgesics, the type of pain experienced and the patient’s physical and mental health. That is PPOA’s approach.
“No two persons are alike when it comes to opioid titration; however most patients can have their opiates reduced to be in compliance with CDC guidelines in six months or less,” says Dr. Rivera.