Prescription opioids are commonly used to treat severe or long-term pain. These medicines can help people manage conditions such as chronic back pain, nerve pain, or pain after surgery.
However, opioids also carry serious risks, including dependence, addiction, and overdose. Because of these concerns, many health systems around the world have been trying to reduce opioid prescribing and encourage doctors to lower doses when possible.
A new study from Monash University in Australia suggests that how these medications are reduced may be just as important as reducing them in the first place. The research found that rapidly lowering opioid doses or stopping them suddenly can greatly increase the risk of mental health crises that lead patients to seek emergency care.
The study was recently published in the medical journal Pain.
To understand how opioid dose changes affect patients, researchers examined health records from 1,458 adults in Victoria who had been using opioids for a long time to manage pain. These patients were receiving treatment from 562 general practices and had interactions with three major hospital networks: Monash Health, Eastern Health, and Peninsula Health.
The researchers focused on patients who visited emergency departments between 2018 and 2022 for problems related to mental health or substance use. By linking medical records from primary care clinics and hospitals, the research team was able to examine what happened when opioid doses were reduced.
The findings showed a clear pattern. When opioid doses were rapidly reduced by more than 25 percent within a 30-day period, or when the medications were stopped completely, patients were far more likely to end up in the emergency department with mental health or substance use problems.
In fact, these patients had more than ten times the odds of needing emergency care compared with patients whose opioid doses were reduced more slowly.
In contrast, smaller reductions of 10 to 25 percent over a month did not appear to increase the risk of emergency visits. These gradual dose reductions are already recommended in Australia’s opioid deprescribing guidelines, which encourage doctors to slowly taper medications rather than stopping them abruptly.
The results suggest that gradual tapering is a safer approach for patients who need to reduce or stop opioid treatment.
The study also revealed other factors that may increase risk during opioid dose reductions. Some patients were also taking medications such as gabapentinoids, benzodiazepines, or other drugs used to treat mental health conditions. These medicines can affect the brain and nervous system.
Patients who were using these additional medications appeared to face even higher risks during opioid dose reductions. This finding suggests that doctors should take extra care when managing opioid tapering for patients who are already taking several medications that affect mood or brain function.
When researchers looked at the reasons patients went to the emergency department, they found that many visits were related to serious mental health concerns.
The most common problems included depressive episodes, which accounted for about 16.9 percent of cases. Suicidal thoughts were reported in about 12.7 percent of cases, while anxiety disorders made up about 11 percent of the presentations.
These findings highlight how closely pain treatment, mental health, and medication use can be connected.
Opioid medications have been linked to serious public health problems for many years. In Australia, opioids have been the leading cause of drug-related deaths for more than two decades. Around two-thirds of these deaths involve prescription opioids rather than illegal drugs.
In response to these concerns, doctors have been prescribing fewer opioid medications in recent years. In fact, opioid prescribing in Australia has dropped by about 18 percent since the period between 2016 and 2017.
Despite this decline, millions of Australians still rely on opioids to manage chronic pain. This means that many patients will eventually need to reduce or stop these medications, making safe tapering strategies extremely important.
Dr. Monica Jung, the lead author of the study, said the results provide an important message for doctors and patients.
She explained that reducing opioid doses slowly does not appear to increase the risk of mental health emergencies. However, rapid or abrupt reductions can have serious consequences. According to Dr. Jung, this shows that opioid deprescribing must be done carefully, with proper planning and close monitoring.
Gradual tapering allows patients to adjust physically and emotionally as their medication levels decrease. This approach can help reduce withdrawal symptoms, prevent sudden increases in pain, and lower the risk of mental health crises.
Professor Suzanne Nielsen, Deputy Director of the Monash Addiction Research Centre and a co-author of the study, emphasized that patients need support during this process.
She explained that while reducing opioid use is important for public health, each patient’s situation must be considered individually. Some people may need additional support from doctors, mental health professionals, or pain specialists when reducing their medication.
Patients who are also taking medications such as benzodiazepines or other psychiatric drugs may require even closer monitoring during opioid tapering. Without careful management, the combination of medication changes and underlying mental health challenges could increase the risk of serious complications.
The researchers say their findings should help guide clinical practice and health policy in the future. Health systems may need better ways to identify patients who are at higher risk during opioid dose reductions and provide additional support for them.
More resources may also be needed to help doctors manage opioid tapering safely, particularly for patients who have long-term pain conditions or mental health concerns.
Overall, the study highlights an important lesson in modern medicine. Reducing opioid use is important, but the process must be handled carefully. Abrupt changes in medication can create new health risks, while gradual and supported reductions appear to offer a safer path forward.
By improving how opioid tapering is managed, doctors may be able to reduce both medication risks and the chances of mental health crises, helping patients transition safely to other forms of pain care.
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