Tapering patients off opioids is happening more. Now there are more questions about how safely it is being done.
New research from UC Davis Health physicians shows tapering can occur at rates as much as six times higher than recommended, putting patients at risk of withdrawal, uncontrolled pain or mental health crises.
The study — “Trends and Rapidity of Dose Tapering Among Patients Prescribed Long-term Opioid Therapy, 2008-2017″ — was presented at the North American Primary Care Research Group meeting in Toronto this week and published online by the Journal of American Medicine.
“Tapering plans should be based on the needs and histories of each patient and adjusted as needed to avoid adverse outcomes,” said study author Alicia Agnoli, assistant professor of family and community medicine in an article published in Science Daily. “Unfortunately, a lot of tapering occurs due to policy pressures and a rush to get doses below a specific and sometimes arbitrary threshold. That approach can be detrimental in the long run.”
The study team found out that the tapering rates were not consistent with the CDC recommendations.
“We wanted to understand how often opioid dose tapering happens, how rapidly patients’ doses were being reduced when tapering, and which patients were more likely to have doses tapered,” said lead author Joshua Fenton, professor of family and community medicine.
Fenton and Agnoli looked at records of 100,000 commercial and Medicare patients. It focused on individuals whose opioid doses were stable for at least a year and identified tapering patients as those with a 15% or more reduction in daily MMEs during a seven-month follow-up period.
Tapering was much more common in patients prescribed higher opioid dosages and increased significantly after the CDC guidelines were published.
As many pain patients have experienced, researchers believe the 2016 policy could have been misinterpreted, leading many prescribers and health systems to insist on faster-than-recommended tapering.
“There is definitely a lot of pressure to reduce opioid use among patients, but there also is a need for more training and guidance for prescribers on how to help them safely do so,” Agnoli said.
For chronic pain patient advocate Terri Lewis Ph.D., there is a simpler explanation. The DEA pressure has frightened doctors, many of whom have stopped treating chronic pain patients.
The problem is one of whose risks/benefits are most important to you to manage when the DEA is sending you letters for doing what you can do with the available resources to care for your complex patients?” she asked on Twitter.
We will have more from Dr. Lewis on this subject later this week.