Opioid Rotation: What Is the Rush?

There are no two people in pain management that I can think of who have saved more lives than Drs. Webster and Fine. In their piece suggesting a new paradigm for opioid rotation [1], they add a distinctly useful clinical approach to what heretofore has been their empirical, political, and advisory efforts in this domain. Dr. Webster has worked tirelessly with his Lifetree foundation and with the Utah Department of Health to attempt to reduce overdose deaths through his empirical studies, root cause analyses and educational websites such as his zero unintended deaths website. Dr. Fine has made multiple contributions to this area, but few may know that he recently had to fight with a third party payor to get them to rescind a dose conversion table they had printed up for use as they urged physicians in their plans to switch patients to methadone to cut costs; this table contained a conversion to methadone from other opioids, which if widely employed in the plan, would likely have led to many, many deaths. With their present contribution, they are attempting to simplify and render safer a process that is poorly understood and practiced in tremendously divergent ways.As I read their article, I am tempted to put it into a bit of historical context. I …