It is with much enthusiasm that we read the article “ Dialing back opioids for chronic pain one conversation at a time ” ( J Fam Pract . 2018;67:753-757) about the author’s approach to opioid tapering. We have implemented a similar process in our own medical home practice, based on the continuity relationship and the Ecological Systems Theory.
The use of the human resources within the medical home—care coordinator, pharmacist, community health worker, etc— distributes the responsibility and lessens the burden of care for the family physician. The Ecological Systems Theory provides a structure for understanding the interaction between proximal influencers (eg, the team) and more distal influences (eg, national guidelines and institutional mandates).
Recently, we presented our findings at the 2018 North American Primary Care Research Group (NAPCRG) Annual Meeting. Our results showed a 50% decline in per capita medication use over an almost 14-month period.
We feel that opioid tapering provides both a counterpoint and a complementary method to medication-assisted therapies (MAT). A counterpoint, because MAT involves the diagnosis and treatment of opioid misuse disorder. At the core of that diagnosis is the question of whether all chronic opioid use should be labelled as “misuse.” Tapering involves no such diagnosis and focuses on the safety of minimal opioid use, which, when MAT is used appropriately, is also a primary concern.
We appreciate the approach that the authors took in their project and look forward to seeing further iterations.
Bharat Gopal, MD
Cristina Capannolo, DO