Discontinuing chronic opioid therapy for pain may not reduce mortality risk and may be associated with an increased risk for overdose death, according to study results published in the Journal of General Internal Medicine.
For this retrospective study of 572 patients (mean age, 54.9 years) with chronic pain, researchers examined the mortality, prescription opioid use, and primary care utilization data of individuals enrolled in an opioid registry at a primary care clinic in an urban safety-net hospital.
In this cohort, 60.1% of the patients were discontinued from chronic opioid therapy, most commonly because they were relocating/transferring care or for a provider-initiated reason. Of these patients, 73.8% subsequently filled ≥1 opioid prescription, and 54.4% continued to visit the clinic during the remainder of the study period.
Patients who discontinued vs continued chronic opioid therapy were found to be at greater risk of dying from any cause (hazard ratio [HR,] 1.27; P =.219), even after adjusting for age and race (HR, 1.35; P =.122).
A total of 119 patients (20.8%) died during the study period; 21 deaths were caused by overdose; 17 of the deaths occurred in patients who discontinued chronic opioid therapy (4.9%) and 4 deaths occurred in patients who remained on chronic opioid therapy (1.75%). The HR for death from overdose among patients who discontinued chronic opioid therapy was 2.82 (P =.062) and 2.94 after adjusting for age and race (P =.049).
Study limitations include the use of a clinic registry rather than pharmacy records.
“While more research is needed to evaluate the generalizability of these findings and to understand how to better protect patients on chronic opioid therapy from harm, caution when discontinuing chronic opioid therapy is appropriate. Improved clinical strategies, including assessment and treatment of opioid use disorder and multimodal pain management, may be needed for patients being considered for opioid discontinuation,” noted the study authors.
James JR, Scott JM, Klein JW, et al. Mortality after discontinuation of primary care–based chronic opioid therapy for pain: a retrospective cohort study [published online August 29, 2019]. J Gen Intern Med. doi: 10.1007/s11606-019-05301-2