Stanford Pain Chief Tells Oregon—Don’t Do It!

Stanford Pain Chief Tells Oregon—Don’t Do It!

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

  1. Reject the portion of the proposal that endorses mandatory taping of opioid medications as detailed in its January 2019 report.
  2. Align all opioid-related policies with federally-issued guidance from the CDC and other public health agencies.
  3. 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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Authored by: Ed Coghlan

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Lisa Bennett

Listen- it is federal law that the disabled cannot be stigmatized for their disabilities, that accommodation must be made by any entity that receives federal funds. We have grounds for a CLASS ACTION LAWSUIT. But, no one is going to hand us one. We need an online petition for disabled/chronic pain patients to sign. When we have thousands of signatures, we can then find an attorney to work with us by showing that we already have enough people for the lawsuit. No one, anywhere, does anything in medicine unless money is involved. So we will sue their asses into the ground. An attorney can advise us as to who we can sue. WE HAVE A CASE. Now we have to ORGANIZE.


I’m thinking that soon, many folks would just as soon die incarcerated or by execution, as well as from agonizing pain filled death delivered by the whim of the “committee”.
They would not give the committee the satisfaction of a complacent death.
They may even take a number of the committee along for the ride.
I don’t think that the committee would then enjoy any amount of sympathy.

I just don’t understand why it has not happened on a large scale already. I wish a sociologist would weigh in on this matter. Perhaps it is because most of our generation was brought up with morals, compassion, forgiveness and a good heart.
Even the most loyal can be provoked to exterminate the antagonist.

Jeffery Fischer

Dont do it

James Robert De caro

We need to take it to the streets, we need a rally if anybody out there has the knowledge to initiate it I’m there as are many other seniors this countries baby boomers need to get it out there just like in the 70s you are a strong force contact your Congressman your state reps advising that they’re out on their ass if they continue with support this abuse of people with medical disabilities being subjected too archaic , barbaric measures especially being derived thru the personal effects of the cdc’s directors family problems, ,and the politicians support of drug cartels, to take up the business of supplying these patients since you won’t be getting any medication from your personal physician anymore and where there is a need ,there will be somebody willing to fill it for that almighty dollar. Call and speak to representatives and ask him if they support drug cartels because that’s exactly what they’re doing if they deny pain medication to there patients

As a physician in Roseburg, Oregon, I have been dealing with DCIPA and the Umpqua Health Alliance forced tapering of OHP patients since 2013. Some patients were taken off with no taper at all, while other were given rapid tapers contributing to withdrawal and other side effects landing some of them in the ER. The Oregon Health Authority doesn’t truly care about patients’ quality of life, etc.. They are only interested in getting as much money from the government and redistributing it among the healthcare providers and systems in Oregon. The contracted organizations (CCO’s) that “manage” OHP funds in the various counties DENY medications that OHA says ARE covered. Why do the subcontracted organizations get to change the rules? It’s because they are only interested in saving money. By denying services, labs, imaging, and medications, they save money for themselves. That savings is passed on to their practitioners as bigger bonuses. It is an obvious conflict of interest but it continues to exist all across the state, especially with our local CCO failing to allow open-public meetings on their discussions of finances and care. They have used funds to dissuade politicians from voting for mandatory public meetings. So as a private for-profit organization using state and federal tax-payer funds they refuse to be held accountable by the public. Some CCO’s have generated millions in profits and have been sold to out-of-state corporations because of such profitability making millions for the original Oregon doctors who created the CCO. Why is there not more oversight of these CCO’s, especially the for-profit ones? They probably pay off anyone who might stand in their way, as they did the Oregon legislators. Oregon’s “democratic” party is corrupting the state, failing to hold government employees accountable for their actions that would lead to lawsuits in the private sector, redistributing tax-payer funds into private hands of those in power, and so much more.


I fear we may think that the CDC has seen the errors of their ways only to find they have just changed the delivery. If you go on the CDC web site print off the new and improved CLINICAL POCKET GUIDE TAPERING pdf. Our doctor shared it with us during our visit this week. It was hot of the press. Reminded me of and old line my dad used. I CAN TELL THE TRUTH A HUNDRED DIFFERENT WAYS WITH OUT LYING. WHAT DO YOU WANT TO HEAR?. The update sounds like more of the same only it dose not reference 90 mme it uses the numbers 50 mme. I pray I’m wrong and just being the devils advocate.


I live in Illinois and they will only pay for the cheapest of the two opioids I depend on to stay alive furthermore they forced my doctor to lower the morphine by 10mgs and put me on a much much cheaper version that doesn’t work nearly as well. I cannot afford the $85.00 per month the Oxycodone costs but facts are simple lower or take it from me and it leaves me no longer a choice suicide will be my only choice. I am forced to go through steroid injections every six months like it or not if I don’t cooperate I lose everything immediately state and Medicaid makes all of my major medical decisions my doctors really are wonderful people and fight for me but rarely win.
I one week ago today was diagnosed with a terminal illness with about three years to live I have Idiopathic pulmonary fibrosis an untreatable/incurable disease my only hope is a lung transplant which I was informed by my PULMONOLOGIST that medication will not approve so I will die end of story that’s insurance it’s a death warrant for the impoverished people of America. Orgeron I will pray for you and fight with you while I am able these laws are hideous at best Dr. MACKEY OBVIOUSLY CARES ABOUT HUMANS COPY HIS LETTERS AND KEEP THEM HANDY THEY ARE A GOOD WEAPON GIVE YOUR DOCTORS A COPY TO MAKE SURE THEY ARE INFORMED ALSO.

What has America become

I do NOT have Medicaid but this is 100% DESCRIMINATION!!! Period – if you suffer in pain you deserve medication! Many people on Medicaid are disabled on SSI with little income per month which is why they qualify. Many disabled suffer with painful conditions! You also have kids on Medicaid in which if they needed due to childhood cancer, trauma, etc just like the adult – so just screw them! I’m ashamed of our Government! I’ve long knew it was corrupt! However, it continues to keep hitting lows that even shock me! I’ve Always said you’re only as good as your coverage! Looks like I’m right! This should be unconditional! If I were granted one wish it would be to move out this disgrace of America that is no longer land of the proud & free. There is little to be proud of anymore & everything comes with a cost especially our health & suffering! What is this country coming too!

Sharon C.

How much longer will poor people in the US permit the rich to abuse them? Surely, taking away pain meds based on financial status is blatant abuse. When desperate people, who have nothing more to lose, rise up against those who abuse them, violence becomes inevitable. To those who conjured up a plan to deny pain meds based on money, I say shame on you! Beware of the last straw!

Thomas Wayne Kidd

Thank you Dr. Mackey for being a wise and caring person. Politics absolutely must be separate from the medical field. Doctor’s autonomy should never have been taken from them, and placed in the hands of Pharmacists. Walgreens has especially went overboard with the CDC’s recommendations as well as many pain clinic doctors. This insanity must stop now. Chronic pain patients on Medicaid should never have been targeted. They drug problem is on the streets and anyone with brains should know this. Government is growing bigger and bigger and soon will be in every part of our lives. Doesn’t matter which party is in control. Insanity has affected the whole country and the world and will only grow worse. Perhaps a little lull in this will help for awhile.

edit to previous comment: they ‘know’ that since we’re just stupid lazy malingering parasitic addicts, we gotta have addiction treatment, not pain meds, This should be obvious, but I thought I’d add it in.

Rosalind R;
The only connection between Medicaid recipients & experimenting upon them –that is what they’re going to do– is that Medicaid people have no power. they are poor. They are ill. They cannot hire lawyers & such to defend them. the Oregon Extremists are going after them because they can.

the medicaid folk are merely the first victims; the Oregon Task Farce plans to extend their opioid ban to everyone (tho we all know rich folk will still be able to get whatever they want/need). The Task Farce members sincerely, strongly believe that NO ONE needs pain meds, unless they’re addicts (which they insist all so-called “chronic pain patients” are). they loaded their group with only people that believe as they do, all with the same ideas & goals, & they have completely resisted all attempts at reason, science, medical facts, & knowledge. They describe CPPs in exactly the same terms that Klan members use to describe people of color (we’re ignorant, subhuman, lazy, drug-addled, stupid, overly emotional, hysterical, etc); they have only increased their contempt of us in the two+ years they’ve been on this campaign.

I live, God help me, in Oregon. If I had any money at all, I’d have left long ago. The politicians & medical leaders in this state make national leaders look like paragons of virtue.

Oh yeah; the Oregon Nuts want very badly to set the tone for the entire country. Good luck, everyone in other states.

Bill Halper

Once again, politics over human rights. Do they not see that the suicide rates have increased because of this inhuman “suggestion of opiate reduction” stemming from the CDC? Or do they care? With so many governmental agencies now pleading not to involve those with Chronic Pain Syndrome (or certain pain related health issues) with this opiate reduction, are they listening? Apparently there must be some reason why Oregon wants to push those who are enrolled in the Medicaid program to just go away. I would sure love to know their reasons.


I find that the “cut it in half for 2 weeks then stop use” routine never takes into effect it WAS JUST cut in half. Arbitrarily cutting it in half is stupid. Check for dose and symptoms then consider if it needs to be cut in half would be closer to allright. But that is not done.

I take about 1 or 2 tabs in a WEEK. So they would cut that to half-one tab?


Rosalind Rivera

I am a chronic pain sufferer and I do not have Medicaid. I also applaud efforts to carefully review illegal and abuse of Medicaid, all fraudulent abuses of Medicaid. What I do not comprehend is the connection between pain and Medicaid. Do Pain management control agencies not realize as any mentally function human being should that being a recipient of Medicaid does not exclude an individual from having pain? This I need to have clearly explained to me because I do not comprehend the justifications of tapering or withdrawing pain medications to those individuals proven through x-rays, sonograms etc..that need their continued pain medications.
Rosalind Rivera
Lucerne Valley, Ca.

Gary Raymond

We must remove politics from medicine. Lawyers should not be telling doctors what to do. How many of us have heard jurists say, “Which law school did you attend?”, intimidating those trying to defend themselves. The question for legislators should be, “Which medical school did you attend?”


Discrimination against the poor a law suit waiting to happen Gov ober reach and abuse of power