Not all patients on prescription opioids misuse them.
New research from the Boston University School of Medicine shows that patients who use opioids to manage pain may not have to be taper off of them if they don’t show any signs of abusing the drugs. The findings were published online last month in JAMA Network Open.
Because of the opioid epidemic and the prevalence of opioid use disorder (OUD), there is a widespread perception that patients should taper off usage (or end it after their prescriptions run out automatically) in order to reduce the risk of misuse. However, this may not be beneficial for everyone to do, namely for those who do not have the propensity for developing an addiction. The perception stems from 2016 Centers for Disease Control and Prevention (CDC) guidelines recommending tapering.
For their study, Investigators analyzed data for almost 200,000 patients who did show signs of OUD and were receiving opioid treatment. They compared three ways of dosing, including abrupt withdrawal, gradual tapering, and continuation of the current stable dosage.
The team found that there was a “higher adjusted cumulative incidence of opioid overdose or suicide events 11 months after baseline among participants for whom a tapered dosing strategy was utilized, compared with those who continued taking a stable dosage. The risk difference was 0.15% between taper and stable dosage and 0.33% between abrupt discontinuation and stable dosage.”
“This study identified a small absolute increase in risk of harms associated with opioid tapering compared with a stable opioid dosage,” wrote Mark LaRochelle, MD, assistant professor of medicine, Boston University School of Medicine, Massachusetts, and colleagues. “These results do not suggest that policies of mandatory dosage tapering for individuals receiving a stable long-term opioid dosage without evidence of opioid misuse will reduce short-term harm via suicide and overdose.”
The investigators note the CDC’s 2016 Guidelines for Prescribing Opioids for Chronic Pain, “recommended tapering opioid dosages if benefits no longer outweigh harms.” In response, they said, “Some health systems and U.S. states enacted stringent dose limits that were applied with few exceptions, regardless of individual patients’ risk of harms. By contrast, there have been increasing reports of patients experiencing adverse effects from forced opioid tapers.”
Sudden discontinuation of opioids can lead to extreme destabilization and sometimes hospitalization. Opioid withdrawals can be deadly if not properly treated, even if they’re not typically life-threatening.
“Previous studies that identified harms associated with opioid tapering and discontinuation had several limitations, including a focus on discontinuation, which is likely more destabilizing than gradual tapering,” the researchers wrote. “There is also a high potential for confounding in these studies.”
For their study, investigators referred to 8-year data from January 1, 2020, to December 31, 2018, taken from a large database which includes pharmacy, outpatient, and inpatient medical claims for individuals with commercial or Medicare Advantage insurance encompassing all 50 states, the District of Columbia, and Puerto Rico. Patients “diagnosed with substance use, abuse, or dependence or for whom there were indicators consistent with OUD were excluded,” the team noted.
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