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Opioid prescription reduction is linked to worsened pain and depressed mood, according to a study released Tuesday by the University of California Davis School of Medicine and published in the Journal of the American Medical Association.
Study researchers examined the potential risks of opioid dose tapering — when a reduced amount of medicine is prescribed over time to reduce drug dependency or overuse. They found that patients on stable opioid therapy who had their doses tapered had “significantly higher rates of overdose and mental health crisis, compared to patients without dose reductions.”
The study used enrollment records and medical and pharmacy claims for 113,618 patients prescribed stable higher opioid doses for a one-year baseline period and at least two months of follow-up. Researchers looked at emergency department visits or inpatient hospital admissions for any drug overdose, alcohol intoxication or drug withdrawal and for mental health crisis events such as depression, anxiety or suicide attempts.
The researchers then compared outcomes for patients after dose tapering to those for patients before or without tapering and found a 68% increase in overdose events and a doubling of mental health crises among tapered patients. The risks of tapering were greater in patients who had faster dose reductions and higher baseline doses.
Alicia Agnoli, assistant professor of family and community medicine at UC Davis School of Medicine and first author on the study, said in a statement that the research “suggests that patients undergoing tapering need significant support to safely reduce or discontinue their opioids” and that clinicians and patients need to carefully weigh the risks and benefits of both opioid continuation and tapering in decisions regarding ongoing opioid therapy.
“We hope that this work will inform a more cautious and compassionate approach to decisions around opioid dose tapering,” Ms. Agnoli said.
The use of opioids for pain management in workers compensation continues to decline, replaced by non-steroidal anti-inflammatory drugs, muscle relaxants and dermatological agents. And while the industry lauds the decline in opioid prescribing, the uptick in usage of the more-expensive alternatives is causing concern.