In order to gain greater insight into the opioid crisis, researchers from the University of California Davis Health examined how doctors' decisions to taper patients off these addictive medications have changed over the past decade.
"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, professor of family and community medicine, in a statement.
In 2016, the US Centers for Disease Control and Prevention (CDC) released a new set of guidelines cautioning against long-term opioid prescriptions, due to the addiction and overdose risks associated with these dangerous pharmaceuticals. The CDC recommended dose tapering — a gradual reduction in the daily dosage of medication — if the long-term risks of opioid use began to outweigh the benefits. The rate of this tapering should be no more than 10 percent of the total dose per month, the organization advised.
"Tapering plans should be based on the needs and histories of each patient and adjusted as needed to avoid adverse outcomes," said study co-author Alicia Agnoli, assistant professor of family and community medicine. "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."
Researchers examined medical and pharmacy claims covering over 100,000 patients enrolled in either commercial health insurance or Medicare Advantage programs between 2008 and 2017. From this diverse group of subjects, researchers identified adults with stable, high-dose opioid prescriptions. The study reports that dose tapering became increasingly common throughout the study period, increasing from 10.5 to 13.7 percent from 2008 to 2015, and from 16.2 to 22.4 percent from 2016 to 2017.
But researchers also found that doctors were tapering patients off of these drugs at much faster rates than the CDC recommended. The average patient was tapered off at a rate of 27.6 percent a month, nearly three times faster than the guideline of 10 percent per month. 20 percent of patients were tapered at 40 percent per month, and 5 percent were tapered at 60 percent a month or even faster.
“After reports of patients experiencing withdrawal symptoms, psychological distress, and suicidality after rapid dose tapering, the FDA recently issued a safety announcement cautioning clinicians regarding the potential hazards of rapid dose reduction among patients taking long-term opioids,” the study authors wrote.
"There is definitely a lot of pressure to reduce opioid use among patients, but there also is a need for more training and guidance for prescribers on how to help them safely do so," said Agnoli. "Ultimately, we want to clarify the effects of tapering on patients and how to help them taper to maximize benefits and minimize risks," Fenton added. "We expect this line of research will have important implications for how physicians manage and monitor patients who are undergoing opioid tapering."
Recent research into the interaction of medical cannabis and opioid use may provide doctors with a safer means of helping wean patients off of these addictive drugs. Several recent studies have found that medical marijuana, including federally-legal hemp-derived CBD products, can help manage the symptoms of chronic pain. Other research has discovered that rates of opioid use and abuse have been decreasing in states with access to medical marijuana, and another recent study found that cannabis can also help patients cut back their use of dangerous illegal opioids.