Potential Unintended Harms of Discontinuing Opioid Treatment For Chronic Pain

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PainRelief.com: What are the main findings?

Response: To address this evidence gap, we conducted a retrospective cohort study of a random sample of people receiving long-term opioid therapy for pain in British Columbia, Canada. We analyzed the medical records of 14,037 patients in British Columbia who had been prescribed opioid therapy for pain for at least 90 days between October 2014 and June 2018. We found that discontinuing opioid therapy for pain was associated with increased risk of overdose among people without opioid use disorder, but the association was even stronger among people with opioid use disorder. We also found that tapering opioid therapy for pain was associated with decreased risk of overdose in those with opioid use disorder who hadn’t been prescribed opioid against therapy (a treatment for opioid use disorder).

PainRelief.com: What should readers take away from your report?

Response: Our findings underscore the need for prescribers to carefully consider the potential unintended harms of discontinuing opioid treatment for chronic pain. Non-consensual and sudden discontinuation of opioid treatment for chronic pain should be avoided given that this may increase risk of overdose, especially for people with opioid use disorder.

Our findings also point to the need for further guidance initiatives to support prescribers in implementing opioid tapering strategies that are personalized to each patient. In particular, to ensure effective treatment while reducing risks, there’s a need for guidance that distinguishes between the needs of chronic pain patients with and without opioid use disorder.

PainRelief.com: What recommendations do you have for future research as a result of this study?

Response: Further research is needed to better understand how to safely and effectively taper opioid treatment among chronic pain patients living with and without concurrent opioid use disorder. For example, studies should examine the extent to which implementing slower tapering protocols, providing close monitoring during tapering, and facilitating access to other supports (e.g., take-home naloxone; care from clinicians trained in addiction medicine) may reduce risks and support positive clinical outcomes. 

Citation:

Discontinuation and tapering of prescribed opioids and risk of overdose among people on long-term opioid therapy for pain with and without opioid use disorder in British Columbia, Canada: A retrospective cohort study

Mary Clare Kennedy ,Alexis Crabtree,Seonaid Nolan,Wing Yin Mok,Zishan Cui,Mei Chong,Amanda Slaunwhite ,Lianping Ti

Published: December 1, 2022

https://doi.org/10.1371/journal.pmed.1004123

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