Nonconsensual Dose Reduction Mandates are Not Justified Clinically or Ethically: An Analysis.

Stefan G Kertesz Ajay Manhapra Adam J Gordon

J Law Med Ethics

Stefan G. Kertesz, M.D., M.Sc., is a professor at the Department of Medicine, UAB School of Medicine and research investigator at the Birmingham VA Medical Center. He is a board-certified internal medicine (American Board of Internal Medicine) and addiction medicine physician (American Board of Addiction Medicine). His research career began in 2000 and he has been funded by both the National Institute on Drug Abuse and the Health Services Research & Development Branch of the Department of Veterans Affairs. He received his MD from Harvard Medical School in Boston, MA and his MSc from Boston University School of Public Health in Boston, MA. Ajay Manhapra, M.D., is Lecturer at Yale School of Medicine in the Department of Psychiatry, Assistant Professor, at the Eastern Virginia Medical School in the Department of Physical Medicine and Rehabilitation and Psychiatry, and Research Scientist at the VA New England Mental Illness Research, Education and Clinical Center. Dr. Manhapra is a board-certified Internist and Addiction Medicine physician with educational, clinical and research focus on pain and addiction. He runs a unique clinic for recovering patients with severe disabling chronic pain and medication or substance dependence at Hampton VA Medical Center, where he is developing an interdisciplinary integrative model for treatment of pain and addiction. Dr. Manhapra received his medical degree from Government Medical College, Thrissur, Kerala, India, and completed his Addiction Medicine fellowship at Yale School of Medicine. Adam J. Gordon, M.D., M.P.H., is Professor of Medicine and Psychiatry at the University of Utah School of Medicine, Director of the Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), and Chief of Addiction Medicine at VA Salt Lake City Health Care System and. He is a board-certified internal medicine (American Board of Internal Medicine) and addiction medicine physician (American Board of Preventive Medicine) with a 20-year track record of conducting research on the quality, equity, and efficiency of health care for vulnerable populations (e.g., persons with opioid use disorders, persons who are homeless, persons with hazardous alcohol use and other addiction disorders). He received his MD from University of Pittsburgh School of Medicine in Pittsburgh, PA and his MPH from the University of Pittsburgh Graduate School of Public Health in Pittsburgh, PA.

Published: June 2020

This manuscript describes the institutional and clinical considerations that apply to the question of whether to mandate opioid dose reduction in patients who have received opioids long-term. It describes how a calamitous rise in addiction and overdose involving opioids has both led to a clinical recalibration by healthcare providers, and to strong incentives favoring forcible opioid reduction by policy making agencies. Neither the 2016 Guideline issued by the Centers for Disease Control and Prevention nor clinical evidence can justify or promote such policies as safe or effective.

Download full-text PDF	Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7938366	PMC
http://dx.doi.org/10.1177/1073110520935337	DOI Listing

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