The Chief of Stanford’s Division of Pain Medicine has urged the Oregon Health Authority Health Evidence Review Commission (HERC) to reject its plan for mandatory opioid tapering of Medicaid patients.

Sean Mackey, MD, PHD pointed out–in a letter dated May 6th—that in the past months, “multiple government agencies have strongly opposed mandatory opioid dose reduction or discontinuation as proposed by HERC.”

Those agencies include the CDC, the FDA, the American Medical Association and the U.S. Surgeon General.

According to Dr. Mackey, these agencies have been alarmed by reports of mandated opioid tapering which cause them to clarify that patients on long-term opioid therapy “should not be subjected to mandated opioid tapering polices or practices.”

Mackey, whose letter was sent to Oregon Governor Kate Brown and other Oregon health policy leaders, said that Oregon’s proposed tapering policy is “extreme” because it imposes an inflexible requirement for complete opioid discontinuation for several populations.

This is not the first time that Dr. Mackey has weighed in on the Oregon proposal. He was one of over 100 leaders in pain and addiction medicine, health policy and patient advocacy that signed a March 7th letter in which, as he wrote, “we raised grave concerns about the lack of scientific evidence backing Oregon’s opioid tapering proposal as well as the lack of any infrastructure for tapering that would ensure patient safety.”

Dr. Mackey called on HERC to

Reject the portion of the proposal that endorses mandatory taping of opioid medications as detailed in its January 2019 report. Align all opioid-related policies with federally-issued guidance from the CDC and other public health agencies. Retroactively rescind its Guideline Note 60 that forcefully tapered patients with conditions of the back and spine in 2016.

A group of Medicaid pain patients in Oregon has been fighting this for nearly a year, an effort that has been chronicled by the National Pain Report. Despite those efforts and the work of national pain leaders and the changing dialogue on the dangers of forced tapering, HERC has not moderated its opioid tapering policy proposal.

On its website, The Health Evidence Review Commission says it “reviews medical evidence in order to prioritize health spending in the Oregon Health Plan and to promote evidence-based medical practice statewide through comparative effectiveness reports, including coverage guidances and multisector interventions, health technology assessments and evidence-based practice guidelines.

Any review of medical evidence that includes what the CDC, FDA, AMA and the Surgeon General are saying, should nudge HERC toward reconsideration.

To read Dr. Mackey’s letter, click here.

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