When harms outweigh benefits of long-term opioid therapy for pain: Need for a new diagnostic entity, research and improved treatments

In our experience, for patients on long-term opioid therapy (LTOT) for chronic pain for whom harms outweigh benefit, but tapering is stalling, misapplying a diagnosis of OUD rarely leads to improvements in patient function or the patient-provider relationship. This condition needs a different treatment approach. Often, such patients will not receive the care they need within OUD treatment programs where clinicians may not be trained to address chronic pain. We believe a new diagnostic entity would align well with guidelines encouraging continuous reassessment of benefits and harms of LTOT and help generate evidence for how to proceed when that balance becomes unfavorable.