Dose reduction may have negative consequences for patients taking opioids for a long time.

(SACREMENTO)

A new study has shown that reducing or phasing out opioid use may have unintended negative health consequences for some patients on long-term opioid therapy.

UC Davis Health researchers studied data from more than 110,000 patients who were on stable long-term opioid therapy. They found that lowering the dose of opioids was associated with fewer primary care visits and a significant increase in emergency room visits and hospitalizations.

There were additional risks for patients with diabetes or high blood pressure. The researchers found a significant drop in their adherence to the medications needed to control their chronic diseases.

“From this current study and others, new evidence is emerging of the previously unrecognized potential harm of gradually tapering stable opioids over the long term,” said Elizabeth Manyan, associate professor of family and community medicine and first author of the study.

Previous research by UC Davis Health has shown an association between opioid dose reduction, mental health crises, and overdose.

“Patients and clinicians need to be aware of both the potential risks and benefits of opioid dose reduction, and also need to think about when and how to reduce opioid doses,” Magnan said.

A woman with short light brown hair and a lab coat

This current and other studies provide new evidence for the previously unrecognized potential harm of tapering stable opioids over time. Patients and clinicians should be aware of both the potential risks and benefits of reducing the dose of opioids, and should be careful about when and how to reduce the dose of opioids.”Elizabeth Manyan

Committed to reducing opioid use

Between 1999 and 2013, opioid overdose deaths accounted for approximately 77% of all drug overdose deaths. In 2014, this figure continued to rise to 81%. In response to the dramatic increase in opioid-related overdose deaths, the Centers for Disease Control and Prevention changed its guidelines for prescribing opioid therapy in 2016.

Since the change in recommendations, dose reduction has become standard practice for patients taking higher doses of opioids due to concerns about overdose and dependence.

According to Manyan, patients and doctors have begun to pay attention to the negative effects associated with taping. As a result, clinicians are beginning to be more careful with tapering and less frequently.

Hand holding pills and water

Additionally, as observations continue to point to adverse effects of taping, the CDC has again updated its recommendations in 2022, emphasizing:

  • Individual patient care
  • Safe and Effective Pain Treatment Options
  • Improving communication between doctors and patients so they can make decisions together about the best care for a patient.
  • Reducing the risks associated with opioid pain therapy, including opioid use disorder, overdose, and death

Findings and conclusions of the study

To assess the constriction, the researchers examined data on administrative requirements. They used the Optum Labs Data Warehouse database, which stores long-term health information about patients of all ages in the United States. The investigators included 113,604 patients aged 18 years or older who received stable doses of long-term opioid therapy for 12 months or more. longer. Data were collected between January 1, 2008 and December 31, 2019. They included patients in general and patients who also had hypertension or diabetes.

The study focused on patients who reduced their dose by 15% or more over a 60-day period.

The researchers found an increase in emergency room visits and hospitalizations in both the general patient population and those with hypertension and diabetes. However, the number of primary care visits has decreased. The authors were unable to determine the reasons for this decline from the available data. They suggest that further research is needed in this area.

Finally, patients with high blood pressure (hypertension) and diabetes showed reduced adherence to chronic disease medications. They also had slight increases in blood pressure and hemoglobin A1c levels, which are associated with complications of these conditions.

It is always important for patients and physicians to have informed, collaborative conversations to make decisions about dose reduction or maintenance therapy. While narrowing may be a better option for some patients, the results of this study give us pause.”Joshua Fenton, Professor and Vice Chair of Research, Department of Family and Community Medicine

What’s next for opioid dose reduction guidance?

The study warns of the potential unintended negative consequences associated with taping, especially for patients with chronic conditions requiring ongoing care. He called for more research that could help inform policymakers and clinicians on how to approach recommendations for opioid use while maintaining a focus on patient-centered care.

“It’s always important for patients and clinicians to have informed, collaborative conversations to make decisions about dose reduction or maintenance,” said Joshua Fenton, professor and vice chairman of research at the Department of Family and Community Medicine and senior author of the study. “While narrowing may be a better option for some patients, the results of this study give us pause.”

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Is the decrease in opioids for pain patients associated with higher rates of overdose and mental health crises?

Financing:

This study was supported by Optum Labs research loan from the University of California and the National Institute of Child Health and Development Eunice Kennedy Shriver (K12 HD051958).

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