Hi Gang, hope everyone is doing okay where you are in this process.
My Dr. has been good about prescribing and my micro taper but it's clear that she doesn't understand it. She's young and smart so I had no concerns about her leaving...and suddenly she did. I got an email on Tuesday that Monday was her last day! Shocking. Luckily, I had built an adequate stockpile as I tapered so I will be fine and have enough supply to completely taper off. It is alarming though and something we should all be thinking about.
That happened to me at an early point during my taper. Gotta love stockpiling! It saved my butt 
It is not uncommon in the U.S. for younger physicians to purchase the private practices of retiring physicians. When this is done, the purchasing physician usually takes over the care of patients from the retiring physician. The patients are often referred to as "Legacy Patients". Here is an article entitled "Caring for Legacy Patients - Standards & Guidelines College of Physicians & Surgeons of Nova Scotia"
https://cpsns.ns.ca/resource/caring-for-legacy-patients/ "Professional Standards and Guidelines Regarding Caring for Legacy Patients
Preamble
In this document, legacy patients are defined as those whose care is taken over by a physician after treatment was initiated by another provider.
The purpose of this document is to guide physicians on the challenges of caring for legacy patients. Physicians must both manage the expectations of legacy patients and independently assess the risk and benefit of their existing treatment plan. These challenges are particularly difficult when involving medication regimes that do not conform to current best practice standards or guidelines.
Professional Standards
Physicians must:
not refuse to accept patients to their care because of the medical condition of the patient or their treatment plan; and
assess the legacy patient and provide patient-centered care, tailored to the specific circumstances and needs of the patient.
Guidelines
Good care should always consider the individual needs and circumstances of the patient. To provide safe and respectful care to legacy patients in particular, physicians should:
consider patient autonomy in shared decision making around treatment expectations. The College encourages the use of agreed upon treatment plans that are documented in the patient record;
regularly review medication regimes and discuss the risks and benefits of medications with legacy patients;
where appropriate, engage the patient in a discussion about tapering of medications to promote a shared decision-making approach;
where appropriate, implement a tapering program that is individualized to patient need and circumstances; and
recognize that tapering is not always possible or appropriate. Vulnerable patients should not be destabilized by the imposition of tapering. There will be circumstances where patients cannot tolerate the effects of tapering or refuse to engage in tapering.
Recommended Reading
College of Physicians and Surgeons of Nova Scotia:
Initiation of Opioid Therapy for Acute Pain
Professional Standard and Guidelines on Accepting New Patients
AMA Journal of Ethics:
Reider, TN – Is Non-consensual Tapering of High Dose Opioid Therapy Justifiable? August 2020
Centre for Effective Practice in Ontario:
Managing Benzodiazepine Use in Older Adults
The 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain
Choosing Wisely Canada
Legacy Drug Prescribing Patterns in Primary Care – Mangin, D et al. – The Annals of Family Medicine Vol 16 No 6 Nov 2018
Document History
Approved by: Council
Approved on: October 15, 2021
Date of next review: 2024"
