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In Reply I agree with Dr Hirsch that not everyone on high-dose opioids for chronic pain fits the National Institute Drug Abuse definition of addiction. My point, which I am sure Dr Hirsch agrees with, is that it is cruel to abruptly refuse to continue opioids to such patients because of concerns that high-dose opioids are more harmful than helpful in this setting. Patients who have received long-term ongoing opioid prescriptions are physiologically dependent on these medications. Physicians should gradually move these patients to safer regimens including adjuvant treatments for pain.
Katz MH. Not All High-Dose Opioid Users are Addicts—Reply. JAMA Intern Med. 2016;176(9):1407. doi:10.1001/jamainternmed.2016.4121