Leading Pain Physician Starts Mandatory Opioid Tapering Program

Leading Pain Physician Starts Mandatory Opioid Tapering Program

Richard L. Stieg, MD, MHS

Richard L. Stieg, MD, MHS

A noted Denver area pain physician has a dilemma.

He’s retiring. He has over 100 patients who use opioids on a daily basis and he’s pretty sure no other doctor will take them.

Dr. Richard Stieg is not your normal run of the mill pain physician. The 78-year old Aurora, Colorado doctor is a founding member and former president of the American Academy of Pain Medicine who has served the pain world in many capacities. (Here’s his bio)

He understands as well as anyone that given the intense scrutiny that the federal government has put on the medical profession regarding opioid prescribing practices the chances are these patients will not be picked up by other doctors if they are using opioids daily. It’s a trend being seen all over the country.

So he’s created a project to help patients taper off their use of opioids.

“Reaction from patients has been less enthusiastic that I had hoped,” Dr. Stieg told the National Pain Report. “Many have refused to comply with even starting a tapering program.” Dr. Stieg understands that and believes it is a combination of fear and reluctance on part of patients who have used opioids for a long time.

Stanford Pain Psychologist Beth Darnall understands the slow rate of adoption.

“We have done a poor job in giving non-addicted people with chronic pain outpatient pathways to support them with opioid tapering. The program we are testing aim to gives patients pain psychology support with their opioid taper.”

Dr. Stieg read Beth Darnall’s Less Pain, Fewer Pills and the two are working together on the project and have created a study that may ignite a conversation about how pain patients are being treated, or not treated, when it comes to reducing opioid use.

Even for patients who are on board with the program, there are barriers to tapering.

The insurance companies aren’t cooperating with reducing patients’ opioid doses.

“It’s beyond frustrating when you write a new prescription for an opioid that they want pre-authorization even if you are reducing the prescription,” Dr. Stieg said. “It’s an unnecessary roadblock and one that most single doctor practices like mine aren’t staffed to do.”

A doctor’s office can spend 30 minutes on hold waiting to talk to someone at the insurance company and then according to Dr. Stieg, “have to explain my reasoning to someone who doesn’t have the training or the background to understand.”

The insurance companies, he thinks, have put these roadblocks to save money.

Another problem is the big-chain pharmacies who he said “have put arbitrary guidelines based on no science whatsoever into place which make it difficult to write a prescription.”

Dr. Stieg will soldier on with his project because, as he says, “my patients need it.”

The project is time consuming for his practice.

He has sent a letter to each patient letting them know he is retiring and has met with dozens of them already.

Following the initial meeting, there is follow-up by Dr. Stieg and his staff every two weeks for four months. The tapering program includes urine drug screens and tracking for marijuana use.

A second tier of the program, depending on the insurance coverage the patient has, will include follow up with psycho-therapeutic support.

A third tier of the program, also again depending on the insurance coverage, includes biofeedback therapy.

The plain-speaking Dr. Stieg says his program isn’t new.

“30 years ago all pain centers were trying to get people off drugs and center on therapies that addressed the cause of the pain,” he said. “It’s what we are trying to do.”

Dr. Beth Darnall

Dr. Beth Darnall

For Dr. Darnall, the project will gather important information and give a “real world look at what people are going through and what’s needed to better support them.  A medical taper alone does not address symptoms of distress that may arise when reducing opioids. We need to provide better pathways to help patients reduce their distress and their pain so that they can succeed with the taper. Also, people need to know that when opioids are tapered slowly and successfully, most patients report less pain.”

And she believes it will make the case that systematic psychological support services should be part of any tapering effort. (Most insurance health plans don’t cover them, which is another hurdle for many chronic pain patients)

But the project goes forward. And there is a lot to learn.

For Dr. Stieg, what is learned from his mandatory opioid tapering program is one last gift he hopes to give the profession of treating pain.

We’ll keep you apprised.

Authored by: Ed Coghlan

There are 12 comments for this article
  1. Heather at 9:24 am

    I am a chronic pain patient and I am being persecuted for health conditions that are beyond my control.

    The attempts to keep people from abusing medications are causing numerous legitimate pain patients to be denied medication or medical care. It doesn’t seem like there’s been an evaluation of whether these methods to curb drug abuse are even effective. Has the impact been studied? Where’s the justification?

    As more chronic pain patients are denied medication, the means that allow them improved quality of life, what’s happening with the suicide rate? From my own experience… if I could no longer go to work, could no longer engage in meaningful social relationships, had difficulties caring for myself or taking care of my home… what’s left?

    Suicide.

    I’m not suicidal. I’ve not been put in the position yet. But it is getting harder for me to get the medication I need. I now have to leave my job once a month to go and pick up a script at the doctor’s office. I can only get a one-month’s supply of my medication.

    I remember when I was working in retail. I would have lost my job over this requirement imposed on me by my doctor’s office.

    I didn’t want to call attention at work to my need to take pain medications. But now I have to take time off work once every month. How to explain this? I DO get treated differently at work. I’ve been seen as being in a vulnerable position, asked if I can continue to do my job when there’s been no indication that I cannot.

    If I lose my job, I lose my health care coverage. What happens if I go to change jobs? I can only get one month’s supply of pills, right? So, how do I start that new job without healthcare coverage to get the medication that keeps me at work?

    Life is complicated and difficult enough, suffering from chronic pain.

  2. melody at 5:52 pm

    I’m not sure if any of you know about kratom. I used to take fentanyl pops and dilaudid both at the same time and both prescribed for the same doctor. the only way that could stand my pain was to take these narcotics. eventually no amount of narcotics would work if I was taken off of them. I was miserable for years. I research every day and so did my friends. I finally stumbled across kratom. kratom work better than a narcotic I have ever had. I no longer have to use a wheelchair or Walker. I was using both of these even when I was on narcotics. I finally have my life back thanks to kratom.

  3. Katie at 5:15 am

    It’s nice of this doctor to ween and understand many of his patients would be left without medication. However, we have a bigger problem at hand. How will many of these patients survive without their medications? For many opioid medications allow people to function and be productive members of society, to play with their kids or grandkids. What will happen when they wean and realize they have no quality of life, depression will set in and suicide will often follow or they will turn to street drugs where they risk their life everytime they want to relieve their pain. It’s a sad world for chronic pain sufferers and it’s getting sadder by the day.

  4. James at 7:59 am

    I have suffered from chronic pancreatitis and sarcoidosis two different pain diseases. There is no cure for either one. I have had surgery and everything. I was taken off pain meds cold turkey and turned to Mmj I don’t know what I would do without it. I wish more people and doctors could learn more about these diseases. We have to put up with a lot from people and we can’t help it! We didn’t ask for these problems they just happen.

  5. trudy myers at 7:46 am

    I could taper-sure…with no pain meds I have no life. I have several sources of pain and I simply cant handle it!! what is it gonna take? someone to be a martyr? maybe go on the news and say hey this is what the DEA and Mds are doing to use in severe pain!! and then blow their brains out?? is that what it will take to wake up our nation? to show we just need the meds to have any life at all?? I wonder…. Im sure they wont post this

  6. Sandy A Sullivan. at 9:40 am

    In Colorado? skip the MJ UA screens – check for other drugs but skip the MJ UA screenings. Someone needs to let the good doctor know that MMJ [and it’s a wide open door in Colorado] helps *lower* opiate use.

    In the past I have been thrown ‘cold turkey’ by a retiring doctor [wasn’t her fault she went into a coma] and that’s the only lifeline i had while waiting 6weeks to see another doctor. MMJ.

    Vaporizers help significantly with pain in the body over *any other method* Less in the brain more in the body. Good luck!

  7. Robin at 8:05 pm

    I think it’s sad. I’ve seen too much death due to non-addicted persons being tapered/weaned off meds they need. Keep adding in therapy and biofeedback, as it adds to the benefit of medication. Wean them off when appropriate, not because a doctor is retiring.

    I wonder how many of those young people will end up turning to street drugs, and/or addicted then dying from OR surviving with the repercussions and stigma of overdose? And why is medical marijuana even in question, when most pain researchers are now in agreement that it is not an issue when combined with opiates?

    While some are lucky enough to manage their pain without medication while young, intractable pain illnesses steal the social lives, familial relations and careers of many while under 40. It’s not okay to make a judgment based on age or appearance, when pain is now easier to prove than ever before. I don’t have a lot of patience for this type of trial and error research, and feel horribly for those who have no options. I truly hope that this is only utilized on a case by case basis, and that this doctor’s patients feel empowered to seek help elsewhere. If not, I pray other physicians in the area take it upon themselves to assist as many of them as possible.

    Marijuana is a good addition to treatment and luckily this is happening in Colorado where it is a legal option. Transition patients to MM at the very least! Sad…

  8. marty at 3:05 am

    I really commend Dr. Stieg for caring enough about his patients to at least try to find a solution and give them the help of weaning off instead of being thrown into it cold turkey. I’m hoping a lot of the younger people with chronic pain take advantage of his help. I however am glad I am not faced with it at this time. I am 63 and worked a good portion of my life with chronic pain with no drugs. I had a family to raise and a job to work no matter what. Now I know what I am about to say will sound heartless but its not meant that way. You seriously can find other means and exercise easier when you are younger. As you get older you aren’t as strong and so many things are giving out on your body. many , many things. I swore I would never turn to having to take drugs but am still proud that I made it to 60. Among other things I could not make it thru a day with my back without the help of these drugs. They dull the pain enough so on a good day I can stand more than 5 minutes at a time. I am able to sometimes make a decent meal even if it takes me hours and on a real good day I can go to the store with my son even though I have to wait in the produce section while he does the shopping. All this with my walker. And I know it doesn’t sound like much but to me it’s life altering to be able to function a little. I will always be proud of myself learning to endure much pain to continue working and I urge anyone who is offered the help try to use it. Try to have as much of a life while you are young as you can. It’s well worth it. Good Luck

  9. Kim Miller at 6:26 pm

    Chronic Pain Patients are being treated as if they are not worth humane treatment with dignity. Why are these patients being denied hope of any semblance of quality of life with no plan to replace the pain medications they will no longer be receiving? The trend is to put the patient through as much red tape, drug testing, pill counts, multiple and extra doctor appointments, and then, despite playing by all of the rules, pain patients are still having their much needed medication taken away. If there was another option being offered that would be great, but there’s nothing in place of the pain medication.

    Life goes on and if you’re in chronic pain, you may just be approaching the end of life as you know it. More sick time if you can even still work, or worse, many have turned to suicide because they cannot deal with the unrelenting, daily pain with nothing to take the edge off.

    We need compassion, dignity and adequate pain care for chronic pain patients. September is Pain Awareness Month. Have some compassion for those in pain and be glad it isn’t you.

  10. Kristine Anderson at 8:43 am

    This is the most absurd solution to this doctor’s “personal problem” of his own retirement. He should be helping his patients to be placed with other doctors, even if it is difficult. I rather think it is more difficult what he is doing than placing these patients elsewhere. I am a long-time pain patient and my pain doctor –a very well-known and respected PMP in southern Florida — would never do this.

  11. Michelle Collins at 8:34 am

    I am a chronic pain patient and also a long time opioid user, I was taken off opioids for a short period of time and I can tell you this that my pain was not less! I don’t know where many of you think that taking opioids increase your pain because being on them help me. I am disabled and suffer from chronic back pain, and with taking my pain meds I am at least able to get out of bed and do some light housework. And at times do some other enjoyable things.