Opioid Dose Tapering, Opioid Dependence, and Indications for Buprenorphine | Annals of Internal Medicine | American College of Physicians – September 2019

This article is significant only because its authors are all founding members of PROP, the group that initiated, escalated, inflamed, and essentially fabricated the whole issue with prescribed opioid medication:

Roger Chou, MD;

Jane Ballantyne, MD;

Anna Lembke, MD.

I’m delighted to see even a tiny crack in the seemingly invincible force of opioid prohibition.



The expanded use of opioids for chronic pain has created a population of patients prescribed long-term opioid therapy lasting years or decades.

This is no different than other medications that must be taken for life, like beta-blockers for high blood pressure or insulin for diabetics, but it’s mentioned here as though it were a problem.

Many people would die without life-long use of blood thinners, blood pressure-lowering medications, or insulin and we certainly would not curtail their prescriptions just because they are being taken “forever”.

There’s nothing intrinsically wrong with needing to take a medication for “years or decades” and even for the rest of life.

apering long-term opioid therapy is challenging, starting with determining whose dose to taper.

This is the first time I’ve seen any of these authors imply that not all patients on long-term opioid therapy must be tapered.

Now they apparently agree that some patients should continue taking those horribly maligned “heroin pills”, even at currently prescribed high doses.

The CDC guideline recommends continuing opioid therapy only in patients with improved function and pain relief, given the risks.

That’s the way it’s always been for most of us pain patients, otherwise, we wouldn’t be taking these medications in the first place.

But there must exist a group of people for whom opioids were prescribed that don’t absolutely need them. Lazy and/or incompetent doctors do exist, and could have been prescribing way too many opioids to folks that only had “aches and pains”.

But for those of us who desperately need them, we’ve already tried all the non-medication and non-opioid avenues of relief, and most of us still do, though in addition to, not in place of, opioids.

Therefore, every patient receiving long-term opioid therapy should be assessed for a taper on the basis of pain; function; and adverse consequences.

I have no argument against this directive, as long as the assessment is done honestly. Unfortunately, honesty has become too rare around this issue.

Thanks to PROP, our taxpayer dollars have been spent on harassing every doctor who prescribes opioids, instead of apprehending the “drug dealers” who maintain a robust street supply of poisonous fentanyl-laced substitutes to the prescription medications that are being taken away from suffering pain patients.

The DEA is the cause, not the cure, for America’s problem with illicit drugs.