Responding to system-wide overprescribing by throwing the switch suddenly in the other direction can have negative consequences for current and future pain patients. Opioid stewardship initiatives and guidance documents in the USA and U.K. emphasize that expanding effective non-opioid alternatives for pain increases the likelihood that less frequent prescription of opioids will be a net benefit rather than a net harm to pain patients. Relatedly, progressively tapering the opioid doses of existing patients should be an individually-tailored activity which is done carefully and slowly, in which prescribers are specifically trained and for which they are compensated. Canada’s de-prescribing network is a promising effort to develop norms of practice in this area. The U.S. Department of Health and Human Services guideline deals well with the complexity of tapering opioid dosage in clinical settings, including shared decision-making to develop a collaborative approach with patients.
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