A new study out this month shows that doctors are increasingly tapering their patients off powerful opioid medications, perhaps so fast that they are putting them at risk. Results of the study, “Trends and Rapidity of Dose Tapering Among Patients Prescribed Long-term Opioid Therapy, 2008-2017,” were published by the journal JAMA on November 15.
“We wanted to understand how often opioid dose tapering happens, how rapidly patients’ doses were being reduced when tapering, and which patients were more likely to have doses tapered,” said lead author Joshua Fenton, a professor of family and community medicine.
In 2016, the U.S. Department of Health and Human Services issued new guidelines on the prescribing of opioid medications in response to the continuing rash of overdoses and deaths that has plagued the country for more than two decades. The guidelines suggested that patients be slowly weaned off opioid medications by reducing the dosage at a rate of ten percent per week or less.
However, some doctors and hospitals have been reducing some patients’ doses more aggressively than federal guidelines, by as much as 15% or more for one-fifth of the patients in the study. In 2008, only 10.5% were being tapered off of opioids that quickly.
Reducing Opioid Use Too Quickly Has Risks
“Stigma and safety fears have made daily dose tapering of opioid prescriptions more common,” wrote Science Daily in a summary of the study. “New research, however, shows tapering can occur at rates as much as six times higher than recommended, putting patients at risk of withdrawal, uncontrolled pain or mental health crises.”
Alicia Agnoli, an assistant professor of family and community medicine and another of the study’s authors, said that tapering plans should be tailored to each patient in order to avoid complications.
“Tapering plans should be based on the needs and histories of each patient and adjusted as needed to avoid adverse outcomes,” said Agnoli. “Unfortunately, a lot of tapering occurs due to policy pressures and a rush to get doses below a specific and sometimes arbitrary threshold. That approach can be detrimental in the long run.”
The study also found that some demographic groups were treated differently than others in the development of tapering plans to reduce the use of opioid medications. Patients who were young, women, minorities, people on higher doses of opioids, people who had recently overdosed, and people on commercial insurance were all more likely to be subject to more aggressive tapering. Dan Laird, a pain physician and medical malpractice attorney, said in a statement that these trends in the tapering of opioid medications are unfair for chronic pain patients, who he says are not responsible for the ongoing opioid epidemic.
“This study confirms that many chronic pain patients are receiving substandard care,” said Laird. “The opioid crisis is largely driven by illegal fentanyl and heroin, yet chronic pain patients continue to be victimized.”
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