Voluntary Opioid Tapering Study Launching at Stanford

Voluntary Opioid Tapering Study Launching at Stanford

Stanford pain psychologist Beth Darnall Ph. D had an interesting thread on Twitter this week talking about the EMPOWER Study at Stanford. Dr. Darnall, who has been an outspoken critic of forced tapering of opioids, explained the study is some detail on Twitter.

The EMPOWER study seeks to address multiple unmet needs of patients with chronic pain who desire to reduce long-term opioid therapy and provide the clinical evidence on effective methodology.

The  EMPOWER study has been active in 4 states for one year. 220 people enrolled so far and are just now completing some patients. Dr. Darnall says they are receiving “terrific feedback”.  It’s whatever opioid reduction goal patients want .

Evidence to date suggests what some chronic pain patients have learned—patients taking long-term opioids require special considerations and protections to prevent potential harms—like increased pain or suffering–from opioid de-prescribing.

Here’s what Dr. Darnall said on Twitter:

“EMPOWER is a *voluntary* opioid tapering study. We do not taper to a predefined dose nor do we ascribe to forced tapering. Our guiding principle is to provide a program that patients want to join and stay in for one year. At baseline, we ask patients the degree of choice they had in the decision to taper opioids and their readiness to taper. Patients complete weekly and monthly electronic surveys from home or wherever is best for them.”

“During their taper, we monitor symptoms weekly and have systems to triage discomfort and adjust the care plan to the individual. We monitor closely for mood changes and suicidality and address issues quickly. Patient safety and comfort are EMPOWER priorities.

“EMPOWER allows for real-time feedback to patients if they report any symptoms or problems. Prescribers receive real-time electronic alerts. We aren’t just collecting data; we are delivering better care to patients while they are in our study. Our prequel study  showed that a few patients increased their opioids during a taper study. EMPOWER replicates this individualized opioid prescribing: we treat the *person*, not the pill.”

“Two-thirds of our patients receive self-management and behavioral medicine treatments during their taper. We are studying these treatments to see if they help patients improve on outcomes, they told us were most meaningful to them, like participation in roles and activities.”

“Patients must be taking daily opioids and have chronic pain to be eligible. We screen and exclude for moderate to severe opioid use disorder. Several members of the EMPOWER study team have spoken against harmful tapering practices that have had tragic results for some patients.”

“While *doing no harm* is a basic first step, it is not enough. We bear an ethical and clinical responsibility to ensure our patients are improving across a range of pain and health outcomes during and after opioid taper.”

“Opioid tapering is not right for everyone, and the complexities of pain and medical comorbidities require individualized opioid stewardship. If patients are doing well on opioids, good function, no red flags, and if they do not want to taper: *leave them alone*.designed to prevent iatrogenic harms from opioid reduction, and ensure we are helping patients live better and do more.”

“The EMPOWER patient voice will be the final judge.”

Like all of you, we’ll be interested—very interested—in the results. 

You can follow Beth Darnall on Twitter @BethDarnall

You can follow the National Pain Report on Twitter @NatPainReport

Authored by: Ed Coghlan

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Maureen M.

@Cindy, good for you!! I understand your experimenting. I do the same. If I ever told my doc that I’m trying new things (even natural things) he would simply discharge me. He already told me over a year ago that I’m not even allowed to try CBD, let alone MM.
All we want is to be healthier and using less meds, if possible. So, we are left to help ourselves as much as we can. Good luck to you!

Scott Watson

I have CRPS, Fibromyalgia, Porphyria, and a litany if other horrible lonely dream killing diseases. There are alternatives to opioids. I mean c’mon. I’ll be 40 this month, and I would have been an addict if I had said yes to legal death dope. Gabapentin is wonderful. Valium for the nerves and seizures. Nsaid’s and Muscle Relaxers. Nothing is going to take the pain away! We wouldn’t be here if we didn’t already know that. I hate to see all of the sadness, negativity, and woe is me. A strong heart and a will to live, even when everything tells us to just give up and die…that is what has helped me. A wonderful counselor. A relationship with God. A Will To Live. ~Scott W.

Cindy

I’m for anything anyone wants to do by choice. I have been doing some experimenting with my medications. I try different things all the time. I would never tell my DR. that tho. I have gotten off 4 pain pills most days I take 2 tramadols. I do also have Hysingla ER which your not supposed to mess with. But I do. I take 3/4 of the pill. Yes, I cut it. So most days I take 2 tramadols ( I can take 6 a day). Some days I take 4, once in a while I take 6.
I have had sleep issues for years. I was taking so much medication for sleep nothing worked anymore. So I starting using pot. I have also lowered the number of sleeping pills I take. Again, I’m not telling my doctor any of this.
Why do I not tell my doctor? Because then the doctor wants to be in control. They tell you how much to go off of. Oh, and if you go off that then you can go off this.
I wanted to have control. I’m doing it slowly and I don’t want someone to tell me how my body is reacting. I know my body.
I don’t know how I can drop down to. But it’s my choice and I know where my comfort level is. It changes from day to day. No doctor will let you get away with making your own choices. So I’ making my own choice.

Ann Sable

Margie, my condolences to you and yours, truly. To Steven, yes that is quite true, sadly. Hello again, Maureen M!
I was never forced tapered, just completely stopped and not of my choosing. Four years with major surgeries (12), all abdominal and now unable to get a Dr to fix my spine…that is in desperate need. I have read through so many comments on every forum, and I have got to say, it is a natural and god given right to every emotion and response. Everything from anger to sobbing. If all were to hush those that are tortured day and night, sleepless wonders and everything in between then, what would be the use if being human at all? Even animals go through similar responses. It’s not so much, as to, conducting yourselves as it is to expressing detrimental experiences day-to-day. And yes, I do read the Good Book and it plainly states the suffering and of those who wish they could die, but death doesn’t come…willing. As for this willing to be tapered off opioids, wishing those the best. As for I and many others whom have been unwillingly tapered and/or hung out to dry, wishing you all the best and god speed.
As for all new comers, please do your research, not all information is correct on some forums and can be quite devastating and detrimental to your health. Blessings to you all…

Jeanette French

I have to say I have mixed feelings about this, pain patients are unable at this time to have any trust in any kind of program or treatment or doctor. We have been majorly harmed by all this and trusting anyone is a major issue. If this is a program that does exactly what you say it does, doing absolutely no harm to the patient and they have the control to go back to their original dose or to have control over their dosing, then kudos. But if this is in anyway just another way to force taper patients, which is what most of patients will think at this time then not so good. Places like rehabs etc want you to give up any control you have over your own choices of medications, try to trick you into lock down ,etc. It is a nightmare that seems endless, and not much progress being made in the nightmare. Patients are under attack and it is not ended yet. Though the CDC did their about face, oh so quietly I might add, the harm still continues to rule the country. It takes a very long time to change the tide of social thoughts, especially when it is the politicians calling the shots and not the doctors who actually understand the issues faced by pain patients. As you can see there is a huge amount of anger and mistrust in the answers below as there should be. Patients have been left to self treat, and die. Their lives have been devastated. To get back any kind of trust in the government and the healthcare system will take alot of time especially when it is still in the mode of harming patients. The tide of better and more caring treatment of pain patients is not yet here and we need to continue fighting for our human rights , decent care and respectful treatment, and literally our lives.

Maureen M.

I think that this is a good study. I have been a CP patient for 25 yrs after my 1st fusion in 2005. I’ve had 3 more spine surgeries, fusions etc since then. I’ve developed CP Syndrome, adhesive arachnoiditis (post 2 Myelograms and a ton of injections), RSD, and Systemic Lupus since.
Although, I have been ‘Doctor forced’ to go through withdrawal twice in the past 5 yrs since the witch-hunt began, been horribly mistreated by docs, pharms etc…
I have been/and currently do take opioids for pain management, for 15 yrs. now.
A new doc heard my cry 2 yrs ago and put me back on my old med/dosage.
I am grateful to still be receiving them. Im one of the blessed ones in that sense.
But, I am aware of the fact that opioids could be negatively effecting my uncontrolled pain levels (ie: the rat in the wheel) and I would love to experiment with a professional for direction and support to guide me to taper over a long period of time SIMPLY to see what ‘my pain’ is truly like without them. ???
I would end up being proved right or wrong, but I’d still like to chance knowing for sure.
I want a healthier feeling body. Yet, my Lupus interferes with it all too though.
Some days I just feel so toxic. It’s all a continuous ‘catch 22’ isn’t it?!
So, I have been using many modalities as well as Kratom to try to attain this myself.
It’s certainly not easy but Kratom does help a lot.
Yet, regardless of what I do…my pain does remain the same, I’m always hurting bad and with or without meds…the psyche part of it plays a huge part in managing our overall health as well. It’s all very complicated, isn’t it?!
Therefore, I appreciate Dr. Darnall working on this for people who ‘want’ to try to taper ‘with help’ for whatever their reason.
Education is the key! I wish the best to all involved!

Don Prue

Opioids aren’t my problem…PAIN IS!!! I can’t take any drug related to morphine which includes dilauded nor can I take synthetics including Fentanyl. Over the course of 17+ years my doctor has tried everything on me. They all have the same effect-they induce pain. Do a study on that! My doctor told me that because I have a very high tolerance for pain I also have a high tolerance for drugs.
The ‘relief’ I get from pain medication is minimal at best. I’ve had 7 back surgeries including the implant and deplant of a spinal cord stimulator (which was a freaking joke).
Surgery #5 was a full spinal fusion which I ended up pulling the screws out of the bones and #6 was a repeat surgery with a repeat result. Now I’m told there is nothing that can be done. I can’t even get nerve blocks because the hardware obstructs access to the nerve root.
My problem is constant, severe pain with no hope for reasonable relief, not frigging addiction.

Mr. Force Tapered

She says her 8.8 million dollar research awarded study aims to reduce opioid use https://med.stanford.edu/news/all-news/2017/09/beth-darnall-receives-funding-to-test-pain-management-strategies.html This award was given almost two and a half years ago when there were actually patients left to taper taper with whatever colorful word you want to put in front of it. Have those of us tapered already been through some form of this already? I can assure you from my point of view at least the results are not good nearly two years later not good at all.

Julia Heath

Thank you @ Dr. James Hamilton, MD. As a former PA who worked in pain management and ER/Urgent Care until my own symptoms pulled me out of my beloved profession, I so appreciate your wise and comforting words. I’m not planning on staying pinned down by my symptoms because I would like not only to go back to work, but also to do more patient advocacy in DC and not just in my home state of Texas. Blessings to you Dr. Hamilton and your practice, and blessings to Dr. Darnall and the EMPOWERMENT program! If my experience as a Healthcare provider and patient with chronic pain can be of use, I’m happy to help! Just contact me at Jheath.dpp@gmail.com or message me at Julia Heath.

One of my good friends is now buried in the ground over this forced tapering. She had tripped over a cord fractured her back, they lowered her pain meds accusing her of being high. Shortly after that she had a heart attack, pain meds for lower it again. She went to a live-in rehabilitation center for physical therapy they lowered her pain meds again. Each time they lured she suffered a heart attack. Now she is dead and gone. All due this lowering of opiates. When she retired from work at age 65 she was living a vibrant life using opiate meds until this fake opiate crisis came along and she was attacked through her medication lowering that killed her. If she had not gone to that facility for rehabilitation on her fractured back she would have never had her medication lowered over and over. But she was trapped in a medical facility. All she wanted to do was to get better. A medical facility killed her my lowering her pain medication. We have to run away from Physical Therapy Rehabilitation that allows you to live there. Is now dangerous to seek help from the certain medical facilities. They’re treating us like we’re all a bunch of rats that they can test on. I hope they end up in chronic pain.

Steven

This reads like revelation. Kill the people and for sure those darn sick people. No doctor has given a rip about what you have or the how much you hurt since not tappering but killing all their patients. 4 years of hell then suicide. You could say I am at risk and all they care about is checking the box taking away medicine. Get a doctor union and stop the madness. We don’t need less we need more meds dummies. After 4 years of this probably 200000 dead. Now there is a useful study.

Kathleen Ganley

https://wp.me/p2x8tw-8xl
New York State Senate Task Force, Senator Keith Brown. Listen to what he says about chronic pain patients. Pain advocates in New York should follow up with him.

Dick fort

I think if a paitent wants to decrease there dose that’s fine but it’s gotta be there choice , most know when I get to a dose and u get a tolerance u need small increase untill u reach that threase hold where u have a comfortable dose , and it should be left there and u should be left alone, unless ur coming in the office all high and [edit] up or having other meds come up in ur drug screenings, I just was forced taper to more then less of what I was getting I begged cried did everything she didn’t give a [edit], take it or leave is what I was told oh and on ur way out make sure u pay the $180 some treatment… Now by decreasing my dose like that and so fast I was have withdraws at night in constant pain no energy felt like shit and I was back to basically bed ridden… It’s totally effected everything I do work is over had to stop , it took everything I had going for me , and what’s worse is I can’t find another doctor they all wanna do stuff I already have done and not give me any meds like therapy, the famous shots ,epurdials which I’ll never have done again , my life was fine before this I had been at that dosage for the last ten years I think if something was gunna happen to me it would of already…. If u have new paitents with cronic pain of course u try every other method first but if that doesn’t work then opoids should be a tool in the tool box and doctors shouldn’t be afraid to use it , as long as they explain everything in detail to the paitents…. People that have been at a comfortable dose for ten years don’t need there doses cut in half or more that’s fucking wrong and unethical in my book, when I was in med school I would of never of done this stuff to people, and if we honestly think the government or doctors or our president or any of them are gunna do something we all better wake up and think again , they don’t care about us Trump wants people not on drugs like he so usually is cause he can’t speak or pronounce words right . He wants health fit pe

There’s actually anyone left that can taper? They already did forced tapering on everyone. I realize that opiods are not for all, that some don’t like them or do well on them. But what Darnell is doing is a study to see how to get the rest of us off the only medicine that works. We’ve been guinea pigs for the last 3 yrs & I’ve had enough. My health went from good to horrible in 2 yrs being forced to half my pain meds. Welcome to the new nazi Germany called America.

Kathy Olszewski

Also did not get any tapering!!!!!!!!

Kathy Olszewski

I would like to be on this survey I took my meds right and now I suffer I was taken off not only my opiods also my insulin dr said I’m cured from ttp. I had only a 10 per cent chance I made it.i went through many changes and challenges then that dr turned my life a living hell see I was told I had to see a dr in my area and since this dr really didn’t anything about my medical problems I also have had many injures,well back to your survey good luck hope you help all the people ,I have been off my meds for a yr now living in hell no sleep

Tony hardy

What an idiot! It’s just another way to justify harming chronic pain patients. These people need to understand that once you taper or decrease your medication intake you can NEVER go back to original dose of medication, that’s the rules according to the new laws in most states. Medical marijuana or CBD is another waste they do nothing for major chronic pain and they are crazy expensive some times costing hundreds of dollars a month, I have known people who spend around $500 a month on marijuana products but pain medication is a fraction of that cost and it works 100% better. This is my opinion and my experience on this matter.

Thomas Wayne Kidd

A voice of reason among all the insanity. Thank you Lord Jesus.

James Hamilton, M.D.

Pain patients need more, not less, opioids — Forty years of clinical experience have taught me that this class of medications have proven to be very effective, safe and reliable for otherwise debilitating pain, and are a Godsend for innocent suffering victims of pain. One hallmark of an advanced civilization is our ability to objectively manage such terrible medical challenges. I pray for a change in our current national obsession with the senseless attack on chronic pain patients.

James Hamilton, M.D.

LMC

I was finally diagnosed with RDS/CRPS in 2006. Because I did not understand that there would NEVER be a time that I would be pain free, my specialist kept upping my meds until I was on 8 Kadian 200mg pills per 24 hours AND 8 Actig 1600mcg lozenges per 24 hours. One morning I woke up and figured out I was still in pain and NO amount of meds would make me pain free. But I also knew that without some pain meds I would not be able the function at all. I reduced my meds all by myself. It was not fun. It was not fast. My doctor was not happy when I told him I had been taking less (remember this was 2010) and dropped me.
After several other specialists I was able to find one that understood that I didn’t want to be a zombie but I also did not want to be a martyr because of pain. From experience I can state that the goal should be less pain not no pain because for chronic pain sufferers there is no such thing!

Holly Davidson

““Opioid tapering is not right for everyone, and the complexities of pain and medical comorbidities require individualized opioid stewardship. If patients are doing well on opioids, good function, no red flags, and if they do not want to taper: *leave them alone*.designed to prevent iatrogenic harms from opioid reduction, and ensure we are helping patients live better and do more.”

Then why am I still being FORCED off my pain medication? ” First do no harm” does not apply to chronic pain patients anymore!

1. laparoscopic cholecystectomy, common bile duct clamped off, was literally ripped up inside had 1500 cc’s of bile pumped out of me, 5 reconstructive surgeries on common bile duct, then 1/2 my liver removed.
2. failed neck surgery..I am so sorry I did this surgery!
3. failed lower back surgery. No more!
4. degenerative disk disease.
5.Osteoporosis
6. interstitial cystitis

Why? Why? Why?