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U.S. health officials again warned doctors Thursday against abandoning chronic pain patients by abruptly stopping their opioid prescriptions. The U.S. Department of Health and Human Services instead urged doctors to share such decisions with patients. The agency published steps for doctors in a six-page guide and an editorial in the Journal of the American Medical Association. (Johnson, 10/10)

After more than 300 medical providers, pharmacists, patient advocates and others emphasized these concerns in a letter to the C.D.C. earlier this year, the agency put out a clarifying statement saying the guidelines did not “support abrupt tapering or sudden discontinuation of opioids,” and warning doctors not to misapply them. The new tapering guide goes deeper, detailing the potential harms to patients who abruptly stop taking opioids and laying out factors to consider and steps to take before starting a taper. It includes several examples of tapering protocols. (Goodnough, 10/10)

"It must be done slowly and carefully," says Adm. Brett P. Giroir, MD, assistant secretary for health for HHS. "If opioids are going to be reduced in a chronic patient it really needs to be done in a patient-centered, compassionate, guided way." This is a course correction of sorts. In 2016, the Centers for Disease Control and Prevention issued prescribing guidelines. Those highlighted the risks of addiction and overdose and encouraged providers to lower doses when possible. In response, many doctors began to limit their pain pill prescriptions, and in some cases cut patients off. (Stone and Aubrey, 10/10)

Millions of people in the United States — an estimated 3 to 4 percent of the adult population — take opioids daily. About 2 million people have been diagnosed with prescription opioid use disorder, according to HHS. There is a consensus in the medical community that these painkillers have been overprescribed and that many patients would have better long-term health outcomes if they cut back on their dosages and took advantage of other types of treatment, ranging from physical therapy to nonnarcotic painkillers. (Achenbach, 10/10)

HHS' assistant secretary for health Dr. Brett Giroir urged clinicians to collaborate with patients on deciding how fast they reduce or stop their opioid therapies. "We know that it is critical that clinicians manage acute and chronic pain in an individualized, patient-centered way," Giroir said. (Johnson, 10/10)

The anxiety around prescribing built in response to the opioid crisis, which drove more than 47,000 fatal overdoses in 2017 alone. The crisis was caused in part by some clinicians overprescribing the drugs, leading to cases of addiction in patients and a source of pills that were diverted. Prescribing levels have dropped since 2012, and some advocates have warned that the fear around opioids has left some patients unable to get them. (Joseph, 10/10)

How much members of the Sackler family should be held accountable for the role their company, Purdue Pharma, played in the nation's opioid crisis will be at the center of a hearing Friday in federal bankruptcy court. State attorneys general are evenly divided over whether to accept terms offered by Purdue to settle some 2,600 claims against it. About half of them say the proposed deal is too lenient to family members who siphoned billions out of their privately held company and stashed much of it overseas. (Mulvihill, 10/11)

An appellate court on Thursday rejected a last-ditch request by Ohio to halt a landmark trial on whether drug companies are responsible for the opioid epidemic, ruling the bid did not meet the strict test for such an extraordinary move. ... Ohio Attorney General Dave Yost, supported by a number of other states, had filed the first request to postpone or dismiss the federal case,. arguing the cities and counties suing drug companies have usurped state authority. Opening arguments in the trial are scheduled for Oct. 21. (Bernstein, 10/10)

A federal appeals court on Thursday cleared the way for a landmark trial over the nation's opioid crisis, rejecting a bid by eight drug retailers and distributors to disqualify the judge, and a request by Ohio and other U.S. states to delay an Oct. 21 trial. The 6th U.S. Circuit Court of Appeals in Cincinnati said U.S. District Judge Dan Polster, who oversees nationwide opioid litigation, had not created an appearance of bias against the drug industry through his rulings, public statements, and efforts to encourage settlements. (Stempel, 10/10)

A U.S. bankruptcy judge on Thursday urged parties that will benefit from a proposed settlement with OxyContin maker Purdue Pharma LP to focus on addressing the opioid addiction crisis and avoid battling over the deal's billions of dollars. The outline of a proposed settlement that Purdue values at more than $10 billion was filed in the U.S. Bankruptcy Court in White Plains, New York on Tuesday. (Hals, 10/10)

Dad was dying, the doctor told James Allen’s family members as they clustered by his hospital bed. Mr. Allen’s family was stunned. He had suffered a heart attack and was on a ventilator in the hushed intensive care unit of Mount Carmel West, a Catholic hospital in a working-class corner of Columbus. But Mr. Allen, 80, had been stabilized, his family said. He could squeeze his son’s hand. His family still believed he would return home to his bedridden wife and his backyard tomatoes. (Healy, Farr, Feiger and Duffy, 10/11)