Coming off chronic opioid prescriptions may bring dangerous health risks

In a new study, researchers found patients coming off opioids for pain were three times more likely to die of an overdose in the years that followed.

The research was conducted by a team from the University of Washington.

Physicians had already begun to reduce opioid prescribing by 2016 when the CDC issued its first guideline on opioid prescribing. That trend accelerated after 2016.

While reduced prescribing may well be intended to improve patient safety, little is known about the real-world benefits or risks of this sea change in opioid prescribing.

The study looked at a cohort of 572 patients with chronic pain enrolled in an opioid registry.

Chronic opioid therapy was discontinued in 344 patients and 187 continued to visit a primary care clinic.

During the study period, 119 registry patients died (20.8%); 21 patients died of a definitive or possible overdose—17 were discontinued patients and four were patients being seen at a clinic.

The team found discontinuing chronic opioid therapy was linked to increased risk of death.

The findings suggest that the policy recommendations intended to make opioid prescribing safer are not working as intended.

The researchers said that improved clinical strategies, including multimodal pain management and treatment of an opioid-use disorder, may be needed for this high-risk group.

At the time of this study, state rules did not allow medication treatment of opioid-use disorder in the primary care setting.

But after those rules changed, the addiction clinic at Harborview has developed a strong program to provide medication treatment for opioid-use disorder, including those who develop problems related to prescription pain medication.

The researchers hope these findings encourage others who prescribe opioids to do the same.

The lead author of the study is  Jocelyn James, assistant professor of general internal medicine at the University of Washington School of Medicine.

The study is published in the Journal of General Internal Medicine.

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