Is reducing opioids for pain patients linked to higher rates of overdose
and mental health crisis?

Date:
August 3, 2021
Source:
University of California - Davis Health
Summary:
A new study found a 68% increase in overdose events and a doubling
of mental health crises among patients who were on stable opioid
therapy but had their doses tapered.



FULL STORY ========================================================================== Opioid therapy is complex. In recent years, a rise in opioid-related
deaths and changing prescribing guidelines and regulatory policies have
led many physicians to reduce daily doses for patients prescribed stable
opioid therapy for chronic pain.


==========================================================================
Some patients have reported that this dose reduction process -- called
tapering -has been difficult, sometimes involving worsened pain, symptoms
of opioid withdrawal and depressed mood.

In a study published Aug. 3 in JAMA, a team of UC Davis Health researchers examined the potential risks of opioid dose tapering. Their study found
that patients on stable opioid therapy who had their doses tapered
had significantly higher rates of overdose and mental health crisis,
compared to patients without dose reductions.

"Prescribers are really in a difficult position. There are conflicting
desires of ameliorating pain among patients while reducing the risk
of adverse outcomes related to prescriptions," said Alicia Agnoli,
assistant professor of Family and Community Medicine at UC Davis School
of Medicine and first author on the study. "Our study shows an increased
risk of overdose and mental health crisis following dose reduction. It
suggests that patients undergoing tapering need significant support to
safely reduce or discontinue their opioids." De-prescribing opioids
for patients on long-term therapy The study used enrollment records and
medical and pharmacy claims for 113,618 patients prescribed stable higher opioid doses (the equivalent of at least 50 morphine milligrams per day)
for a one-year baseline period and at least two months of follow-up.



==========================================================================
It looked at emergency department visits or inpatient hospital admissions
for any drug overdose, alcohol intoxication, or drug withdrawal and
for mental health crisis events such as depression, anxiety, or suicide attempts.

The researchers compared outcomes for patients after dose tapering to
those for patients before or without tapering. They found a 68% increase
in overdose events and a doubling of mental health crises among tapered
as compared to non- tapered patients. The risks of tapering were greater
in patients who had faster dose reductions and higher baseline doses.

To taper or not to taper Guidelines from the Department of Health and
Human Services (HHS) and the Centers for Disease Control and Prevention
(CDC) advise clinicians to monitor patients carefully during tapering and provide psychosocial support. They caution about the potential hazards
of rapid dose reduction, including withdrawal, transition to illicit
opioids, and psychological distress.

"Our study results support the recent federal guidelines for clinicians considering opioid dose reduction for patients," said Joshua Fenton,
professor and Vice Chair of Research in the Department of Family and
Community Medicine and senior author on the study. "But I fear that most tapering patients aren't receiving close follow-up and monitoring to make
sure they're coping well on lower doses." The researchers emphasized
the need for clinicians and patients to carefully weigh the risks and
benefits of both opioid continuation and tapering in decisions regarding ongoing opioid therapy.

"We hope that this work will inform a more cautious and compassionate
approach to decisions around opioid dose tapering," Agnoli said. "Our
study may help shape clinical guidelines on patient selection for
tapering, optimal rates of dose reduction, and how best to monitor and
support patients during periods of dose transition." Other collaborators
on this research include Guibo Xing, Daniel Tancredi, Anthony Jerant,
and Elizabeth Magnan, from UC Davis Health. The study was supported by
a University of California-OptumLabs Research Credit, the Department of
Family and Community Medicine at UC Davis, and the UC Davis School of
Medicine Dean's Office (Dean's Scholarship in Women's Health Research).

========================================================================== Story Source: Materials provided by
University_of_California_-_Davis_Health. Note: Content may be edited
for style and length.


========================================================================== Journal Reference:
1. Alicia Agnoli, Guibo Xing, Daniel J. Tancredi, Elizabeth Magnan,
Anthony
Jerant, Joshua J. Fenton. Association of Dose Tapering With
Overdose or Mental Health Crisis Among Patients Prescribed Long-term
Opioids. JAMA, 2021; 326 (5): 411 DOI: 10.1001/jama.2021.11013 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2021/08/210803121309.htm

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