Overdose death more likely after coming off opioids for pain

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Patients coming off opioids for pain were three times more likely to die of an overdose in the years that followed, research shows.

“We are worried by these results, because they suggest that the policy recommendations intended to make opioid prescribing safer are not working as intended,” says lead author Jocelyn James, assistant professor of medicine in the Division of General Internal Medicine at the University of Washington School of Medicine. “We have to make sure we develop systems to protect patients.”

Physicians had already begun to reduce opioid prescribing by 2016, when the Centers for Disease Control and Prevention issued its first guideline on opioid prescribing. That trend accelerated after 2016.

While reduced prescribing may well be intended to improve patient safety, little is known about the real-world benefits or risks of this sea change in opioid prescribing.

The observational study looked at a cohort of 572 patients with chronic pain who were enrolled in an opioid registry. Chronic opioid therapy was discontinued in 344 patients and 187 continued to visit a primary care clinic. During the study period, 119 registry patients died (20.8%); 21 patients died of a definitive or possible overdose. Of these, 17 were patients who stopped using chronic opioid therapy and four were patients being seen at a clinic.

The researchers conclude, “Discontinuing chronic opioid therapy was associated with increased risk of death in this observational study.”

They say that improved clinical strategies, including multimodal pain management and treatment of opioid-use disorder, may be needed for this high-risk group.

At the time of this study, state rules did not allow medication treatment of opioid-use disorder in the primary-care setting, says coauthor Joseph Merrill, professor of medicine in the Division of General Internal Medicine.

After those rules changed, he says, the addiction clinic at Harborview Medical Center in Seattle developed a program to provide medication treatment for opioid-use disorder, including patients who had developed problems related to prescription pain medication.

“We hope these findings encourage others who prescribe opioids to do the same,” Merrill says.

The researchers say this study in the Journal of General Internal Medicine is the third published this year to look at the risks of stopping opioids:

  • A study in the Journal of Substance Abuse Treatment found that among patients at high dose who stopped opioids, almost half had their doses reduced to zero in a single day, and many wound up in emergency departments.
  • A New York study found that ending opioid prescriptions was often followed by an end to the care relationship.
  • This spring the United States Food and Drug Administration issued a warning that suddenly stopping opioids can present a risk to patients.

Funding came from the University of Washington School of Medicine’s Medical Student Research Training Program, the National Center for Advancing Translational Sciences, the National Institutes of Health, and the Division of General Internal Medicine in the University of Washington School of Medicine.

Source: University of Washington