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At the height of the opioid epidemic, the Centers for Disease Control and Prevention (CDC) released prescription guidelines with the goal of reducing addiction and overdoses. They recommended lessening the dose and number of pills prescribed, yet some doctors decided to cut off patients immediately, without factoring in withdrawal and other side effects.
As more medical professionals look to reduce opioid use and states put together their own prescription guidelines, a recent study from the University of Washington found that patients living with chronic pain who immediately stop taking opioids have a higher chance of fatality.
Results of the Study
Published in the Journal of General Internal Medicine, the study examined 572 patients living with chronic pain who were also enrolled in an opioid registry. From this group, 344 had their doctors stop chronic opioid therapy for pain management and 187 continued to receive medications through a primary care clinic.
During the course of the study, 119 individuals died from an overdose or probable overdose. Many of these individuals had their prescriptions stopped suddenly by their doctors or of their own volition. Only four individuals who overdosed continued to see their doctors.
Based on these results, the researchers determined that patients who suddenly stop taking opioids or have their prescriptions drastically reduced are three times as likely to die of an overdose. In response, researchers suggested a revision to the CDC’s 2016 recommendations: For those living with chronic pain and other high-risk conditions, doctors should look for an alternative course of treatment, such as multimodal pain management or a similar, gradual approach that takes the patient’s physical and psychological issues into account.
Additional Research
The University of Washington study is the third to question and find fault with the CDC’s recommendations. One published in the Journal of Substance Abuse Treatment found that, for patients taking high-dose opioid prescriptions, doctors did not reduce their dosage or taper them off treatment. Among patients in Vermont’s Medicaid program using opioids, doctors simply stopped their prescriptions. In a day’s time, patients experienced an emergency or hospital visit due to opioid-related withdrawal or overdose.
Supporting these findings, a New York-based study published in the Journal of General Internal Medicine found that after a doctor stops prescribing the patient opioids, the patient-care relationship usually also ends, with no follow-up or alternative chronic pain treatment.
FDA Label Revisions
In response to these studies, the FDA requested label changes for opioids and recommended doctors gradually wean patients off these highly addictive drugs, rather than simply discontinue a patient’s prescription.
The FDA claims that patients who suddenly stop taking opioids frequently experience a high level of physical pain and go through withdrawal symptoms. Yet, they allege patients don’t wait it out, instead turning to opioid alternatives, including black-market opioids, heroin or illegal fentanyl.
Furthermore, the FDA says a one-size-fits-all approach is not ideal for discontinuing these drugs. They recommend doctors develop a treatment plan based on the drug’s dosage, how long the patient has been taking it, the condition being treated and the patient’s physical and psychological state.
