Forced opioid tapers are not safe. They are not evidence-based. In fact, the evidence shows that opioid tapers lead to overdose, suicidal ideation and death.
You are not completely powerless, even though it most certainly can feel that way. Here are a few things you can do if you find yourself being force tapered.
If you’re being told your pain medication will be reduced or stopped against your will, you have every right to be scared, angry, and possibly even a little desperate. If you’re on long term opioid therapy, you’ve almost certainly tried every other treatment available. You’ve likely proved, time and again, that with your opioid pain medication you can live a functional life – work, care for your family, move, contribute. And without it, you’re trapped in unbearable pain. Disabled. Suffering.
You deserve compassion, respect, and evidence-based care.
But many doctors now believe that opioids are not effective for chronic pain and that the risks outweigh the harms. This is what they have been taught, despite this NOT being evidence based.
Most doctors now believe that people who have chronic non-cancer pain should be tapered off opioids. Or at the least, everyone should be tapered to a dose that is below 100mg of oral morphine equivalent dose (OMED – usually referred to as MME in the US). Often, they want to taper to less than 60 OMED, which is barely higher than a starting dose for opioid naïve patients.
It does not matter if you have been stable, and doing well, experiencing no side effects, for years or even decades. Many doctors no longer want the responsibility of managing long term opioid therapy. And some will abandon your care.
The bottom line is that you do not get a choice. You are told that your dose is being reduced. You know that this will destroy your ability to function and ruin your life.
That’s not hyperbole, its reality.
But what can you actually DO about it?
Firstly, the most important thing to remember is this:
REMAIN CALM
Do not get upset, no matter how you feel. Do not show anger, or fear. Do not be rude, or make threats against your doctor.
Your emotions can be used against you. The doctor has a reason to discharge you as a patient, if you are rude or threatening. Then you have lost, immediately.
If you are emotional, the doctor could characterize you as hysterical and justify their decision this way. Again, this is playing into their hands.
Do not give them a reason to end the consult. Always keep the higher ground. Demonstrate that you are reasonable and measured. Remain polite and calm at all times.
I KNOW how difficult this is! But it is critical. If the doctor characterises you as unstable, threatening, or mentally ill, they will have grounds to force taper you AND discharge you as a patient. You do not want this, no matter how angry, upset, or betrayed you feel.
If you feel you cannot manage your emotions (fair enough!), ask to make another appointment.
If you have been ambushed…
If this taper has come out of the blue, if you have been taken by surprise, it is OK to ask to make an appointment to discuss this at another time.
This is perfectly reasonable, and in fact most often the best course of action.
It will allow you time to process your emotions and prepare and present a logical, medically sound, case for retaining your opioid pain medications.
Your doctor should agree to making another appointment time to discuss your treatment plan. Make a long appointment so that you have time to discuss all issues thoroughly. And request that your doctor keep your prescription unchanged until then.
This is a very reasonable request! Give yourself the benefit of time, to gather resources and evidence. And to let the initial shock sink in, and manage your, understandably, strong emotions.
Your GP may actually be relieved and agree very readily to this request.
Here’s what you can consider for that appointment:
- Put your refusal to taper opioids on record.
Tell your doctor you do not wish to taper your pain medications and ask for that to be recorded. Follow up in writing and keep a copy.
Note: this is not going to have any practical effect. It is entirely up to the doctor how and what they prescribe, for whom and in what doses. But it’s important that you state that you do not wish to be tapered, and deprescribing your opioids is against your will. Make sure this is on your medical record.
- Request justification.
Ask your doctor to explain in writing the medical reason for the taper and what risks they have considered. You are entitled to transparency. And, again, it’s important this is fully documented. The doctor likely will want to do so for their own safety, anyway. - Buy time. Ask for a very slow taper. Express your concerns but show a willingness to try. And explain that a slower taper is more likely to be successful. This is a very reasonable request that your GP has no grounds to refuse.
- Document how opioids help you function.
Describe in plain language what you can do with medication versus without. Note if you’ve ever become suicidal from pain, this is vital evidence.
If you have been force tapered previously, describe what happened, what the impact was of losing your pain medications.
For example:
Working hours e.g. you can work a 30-hour week with your opioid pain medications. Without your opioid pain medications, you are unable to work more than two hours a day, and you WILL lose your job. This will create financial hardship and mental stress. You have a family to take care of and need to work. Without opioids, you will need to go on disability support which amounts to living under the poverty line.
Describe the health impacts e.g. with pain relief, you can attend gym, walk or jog 5km daily, swim, play tennis, whatever it is you do to remain active, demonstrate that opioids enable this.
Without opioids, your health will suffer. You will lose fitness, muscle mass and strength. Show that you are healthier WITH opioids than without them.
Social life: With opioids you are a productive member of your community. Perhaps you volunteer, perhaps you have a regular card game, perhaps you attend the weekly trivia night. You will lose the ability to do all of these things without pain relief. You will lose social contacts, lose friendships, become home bound, and isolated.
- Seek a second opinion.
I know, this feels almost impossible. And that feeling is justified. It’s very, very difficult to find a GP who will prescribe opioids in the current regulatory climate in Australia.
However, some doctors still practice ethical, patient-centred chronic pain care. We’re working on building a directory to help patients find them, but that resource is not available yet. If you can, get another opinion before your taper begins.
- Search and post in online chronic pain groups.
Search online chronic pain groups in your area for recommendations for GPs who do prescribe opioid pain medications, or post in the group to ask for referrals. Obviously, just because a GP prescribes for one patient, does not mean they will prescribe for you. But it does show a willingness to prescribe proper pain relief and that the GP is up to date with best practice.
- Ask your pharmacist
If you have a good relationship with your pharmacist, you can ask them if they can recommend GPs in the area. Obviously, they have all the prescribing records and will know which GPs prescribe, and which do not.
However, you can’t come right out and ask for a recommendation for a GP who prescribes opioids. This could be construed as doctor shopping and get you into a world of trouble.
Instead, say something like “My GP is leaving the practice. As you know, I live with (painful diseases) x and y. It’s very hard to find GPs who understand complex chronic pain. Can you recommend someone in the area who takes a balanced, compassionate approach to chronic pain?”
If you have a good relationship with your pharmacist, and they know your prescribing history, they will very likely understand what you are getting at. They can’t hand you a list of doctors who prescribe opioids. But they may well say something like:
“Dr Patel is very understanding of complex chronic pain” or
“Dr Kochman is very knowledgeable about long-standing, painful, conditions”
The key is to ask for continuity and compassionate care, not for “someone who prescribes opioids.”
- Never stop suddenly.
Rapid or forced withdrawal is dangerous.
If you are being cut off suddenly, you can ask for a slower taper. Rapid tapers are NOT recommended and are against guidelines, and its fine to politely point that out. You may be forced to ‘agree’ to the taper but ask for a very slow taper.
- Make a formal complaint.
File with your state health complaints body (e.g. the Health Care Complaints Commission (HCCC) in NSW or your Ombudsman, or make a complaint with AHPRA, the federal Australian Health Practitioners Regulation Agency. Focus on the lack of individualized care, the disregard for your safety, and the physical and psychological harm caused by the taper. - Write to your local member of parliament, state and federal.
Write to your local members of Parliament, and senators. Briefly tell your story and ask for help. It’s important to keep it brief and to the point. We can help you write your story and help you write to your local members.
- Join the movement.
Follow Pain Patient Advocacy on Facebook and join our private advocacy group. To learn more, follow Arthritic Chick on LinkedIn and/or Substack and Kevn R James on LinkedIn.
Like and share posts, sign petitions, and participate in advocacy campaigns.
This is IMPORTANT! It’s the single most, simple thing that every chronic pain patient can do to make a difference.
Every interaction (like, share, comment) helps the algorithm push the information to more people and helps push the truth into public view. A Facebook page with 10,000 likes will get more attention from politicians than one with 200 likes. It’s a very small thing for each person to do, but together, we CAN make a big difference.
- Consider telling your story.
Whether anonymously or publicly, share what’s happening to you. Most average people are completely unaware that this is happening. Even most non-GP or pain management doctors are unaware. Tell everyone! Real stories change policy. If you want to be part of one of our campaigns, anonymously if you prefer, please get in touch. - Find community.
You are not alone. Join our private advocacy group, where you’ll find others who understand, have likely gone through similar situations, and can offer practical and emotional support.
Final Note
This situation is unjust, but it’s not hopeless.
The more of us who speak up, document our harm, and refuse to be silenced, the harder it becomes for policymakers to ignore what’s being done to us.
Together, we are correcting the record.