The article, “Harms Versus Harms: Rethinking Treatment for Patients on Long-Term Opioids,“ has been published in SAj.
In this commentary, the authors state that in 2022, the CDC began encouraging clinicians to weight the risks versus harms of continued therapy and empathetically engage patients in patient-centered discussions around continued therapy while avoiding patient abandonment. This commentary discusses how the emphasis on “benefit” will almost always lead to discordance between the patient and provider since many clinicians find little benefit in opioid therapy for chronic pain with evidence questioning its efficacy for chronic pain. The authors believe this disagreement between patients and providers has the potential to lead to unilateral tapers or patient abandonment and further increase patient harm. Considering this dilemma, they propose a revised framework that emphasizes weighing the harms of continuation of therapy against the harms of discontinuation of therapy when caring for patients on long-term opioid therapy. The authors state that this revised harm-reductive decisional framework has the potential to retain patient-provider trust and increase opportunities for engagement in evidence-based multi-modal pain treatment, including non-opioid based treatment options.
In the AUTHORS’ OWN WORDS, they relate the importance of their work:
“In patient care, physicians are counseled to weigh each treatment’s risks against its benefits. But what happens when patients and doctors don’t agree on the benefits of continuing opioid therapy when the risks are almost never negligible and are difficult to predict? A physician-initiated opioid taper without patient buy-in may seem inevitable, despite its potential to precipitate harm. To prevent such harm, we propose a revision to the risk-benefit framework that could help both clinicians and patients approach this fraught decision in a more thoughtful way.”