Opioid  Taper Survey

This survey focuses on opioid tapers and is designed to record the opinions of medical  practitioners who have a waiver to prescribe buprenorphine.

The survey is part of an effort to explore the possibility of making available a standardized oral medication taper approach for patients who wish to reach opioid abstinence and are of average motivation to taper.

Using the SAMHSA website, a random selection was made from the 52,017 practitioners with a buprenorphine waiver, as listed on April 4, 2021. These randomly selected practitioners are being contacted to determine if they wish to complete a survey that consists of three questions.

Once the survey is completed and the responses are compiled, which should be by December 31, 2021, all practitioners who completed the survey will be able to view the anonymous aggregated results.

               Context: Which patients might be candidates for a taper?

A patient who might reasonably be considered a candidate for an effective opioid taper:

1) Is currently stable, through the use of buprenorphine, in appropriately supervised medication-assisted treatment.

2) Would be likely to experience significant symptoms of withdrawal if opioid use was stopped without a taper approach.

3) Is a patient who wishes to complete a taper regimen that leads to their stopping the use of opioids.

4) Is considered by their prescribing practitioner to be a realistic candidate for a taper regimen that leads to abstinence.

What are some specifics about this survey?

This survey is about the idea of using a standardized opioid taper regimen with which to treat such opioid-dependent patients.

“Standardized” here means:
A) All patients who are starting the opioid taper regimen at a specific dosage level of opioid (for example, at some dosage between 1 and 4 mg of buprenorphine per day) then follow the same directions as every other patient starting at that dose, until they reach the end of the prescribed opioid taper regimen.

B) There is limited discussion with a patients about adjusting their dosage, unless a patient experiences withdrawal symptoms that significantly interfere with their feeling comfortable or exceed their capacity to cope successfully without regression.

Patients understand:

A) The intent is for them to remain in treatment throughout the taper, and;

B) If withdrawal symptoms start to become an issue, that they will be able to pause and remain at any reasonable dosage level as long as desired, with the cooperation of the prescribing practitioner.

The three questions in the survey:
The first two questions have brief answers.
The 3^rd question will  likely  require some time to compose an answer.
Here are the three survey questions:

Question 1)  A standardized taper?: Prior to this survey, have you ever thought of designing  a standardized opioid taper regimen that might be effective among  patients who wanted to stop opioid use and who had at least an average level of  motivation to stop their opioid use?

□  Yes, I have thought in some detail about the design of a standardized opioid taper.

□  Yes, but I have thought only briefly about designing a standardized taper, because patients with whom I work require individualized courses of treatment.

□  No, I have not seriously considered a standardized taper.

□  No, it has never crossed my mind to create a standardized taper.

 Question 2) Is a standardized taper a realistic idea? Do you think an effective standardized opioid taper regimen that could be prescribed for most patients who wanted to stop their use of opioids, and are currently stabile in opioid maintenance, is a realistic idea?
“Realistic idea,” here means that, in your opinion, a standardized opioid taper would work with enough patients to justify the cost and time developing a standardized taper.

□ Yes, a standardized opioid taper is a realistic idea. I think it would work with enough patients to justify the time and cost of research.

□ No, a standardized opioid taper is  not  a realistic idea because it is not likely to help enough patients to justify development.

3) Taper design?: Please answer this question, even if you think a standardized opioid taper would not be effective  or  it would not be practical:

If you were to design a standardized opioid taper protocol you thought would have the best chance of being successful with your opioid dependent patients of average motivation to stop opioid use, what would be specifics to such a taper? Feel free to submit one or two designs; better too much detail than too little.

You may assume you have a compounding pharmacy that can make any regimen you design, that is, you are not bound by what is commercially available.

You may assume there is no cost to patient, or to provider, for medication.

You may write a treatment plan in any format.

If you have any questions, please feel free to contact:

Joseph Grossman, MD, LCSW  at   info@pssusa.net    or  Telephone 831-247-7294

It will be most helpful and much appreciated if you are able to make time in a busy schedule to complete this survey.

Thank you.
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