Prescription Opioid Tapering in Community Outpatients With Chronic Pain

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Current algorithms for tapering opioids may be too aggressive, and this low-cost approach may give prescribers a new method to reduce patient risks without supportive services.
Current algorithms for tapering opioids may be too aggressive, and this low-cost approach may give prescribers a new method to reduce patient risks without supportive services.

An opioid-tapering program tailored to the individual patient may be useful for decreasing the dose in patients taking long-term prescription opioids for chronic pain. This research was presented at the American Academy of Pain Medicine Annual Meeting held April 25-29, 2018, in Vancouver, Canada.

For this study, 82 community outpatients (age >18) with chronic pain were offered the opportunity of enrolling in an opioid-tapering program that did not include supportive services. 

Patients who were taking opioids long-term were provided with education on the benefits of reducing opioids by their prescribing physician, and the physicians worked with the patients to develop an individually-tailored program.

Assessment of demographics, opioid and pain data, and psychosocial measures were completed online by patients at the beginning of the study and at 4-month follow-up. A standard morphine equivalent daily dose (MEDD) was used to measure opioid doses.

Of the 82 patients 51 completed the program.  At 4-month follow-up, the baseline median MEDD was reduced from interquartile range (IQR) of 288 (CI, 153-587) to IQR of 150 (CI, 54-248) (P =.002) and exceeded 50% dose reduction. Pain intensity (P =.29) and pain interference did not increase with opioid reduction.

The results of this program suggest that patients are interested in reducing their opioid dose, but that patients taking opioids long-term will need more than 4-months to achieve opioid cessation. The researchers stated that current algorithms may be too aggressive, and “this low-cost approach may supply prescribers with a method to reduce patient risks in the absence of supportive services.”

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Reference

Ziadni M, Stieg R, Mackey I, et al. Patient-centered prescription opioid tapering in community outpatients with chronic pain. Presented at: AAPM 2018; April 25-29, 2018; Vancouver, Canada. Abstract 190.

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