
Taking Opioids Is Deadly, but So Is Stopping Them, Researchers Find
Three studies published this year have examined the risks when patients with chronic pain abruptly stop taking opioids.
When the CDC
Surely, the guidelines stopped many from starting the path to addiction—there are
Patients tapering off opioids for pain were 3 times more likely to die of an overdose in the years that followed the CDC directive. The authors note theirs is the third study published this year to highlight the risks of suddenly stopping opioids. In April, the FDA issued a
The lead author of the University of Washington study, Jocelyn James, MD, assistant professor of general internal medicine, warned that better systems are needed to protect patients from the effects of the 2016 guidelines.
“We are worried by these results, because they suggest that the policy recommendations intended to make opioid prescribing safer are not working as intended,” James said in a statement.
The new study, published last week in the Journal of General Internal Medicine, looked at data from 572 patients with chronic pain who were enrolled in an opioid registry. Chronic opioid therapy was stopped for 344 of them, while 187 continued to visit a primary care clinic. Over the study period, 119 registry patients died (20.8%), including 21 who died of an overdose or possible overdose. Of this group, 17 were patients who had stopped seeing the primary care clinic and 4 were still being seen.
“Discontinuing chronic opioid therapy was associated with increased risk of death,” the investigators concluded.
Tapering patients off opioids can often lead to an end to regular care for the patient, a
“When you and your patient have agreed to taper the dose of opioid analgesic, consider a variety of factors, including the dose of the drug, the duration of treatment, the type of pain being treated, and the physical and psychological attributes of the patient,” the FDA notice states. “No standard opioid tapering schedule exists that is suitable for all patients.”
The FDA encouraged an individualized plan that addresses withdrawal symptoms and psychological distress.
Alongside the FDA warning, CDC published
In addition,
Is there a good way to ease patients off opioids? The time frame of the data collection—2010 to 2015—came before laws in Washington state allowed for multimodal pain management and treatment for opioid use disorder. Rules are different today, study co-author Joseph Merrill, MD, MPH, professor of General Medicine at the University of Washington School of Medicine, said in a statement.
Addiction clinics can now treat patients with medication for opioid use, Merrill said, so high-risk patients are more carefully managed.
Reference
James JR, Scott JM, Klein JW, et al. Mortality after discontinuation of primary care—based chronic opioid therapy for pain: a retrospective cohort study [published online August 29, 2019]. J Gen Intern Med. doi: 10.1007/s11606-019-05301-2.
Newsletter
Stay ahead of policy, cost, and value—subscribe to AJMC for expert insights at the intersection of clinical care and health economics.