"Approximately 10 million U.S. adults are prescribed long-term opioid therapy (LTOT)...."
(vs ~30 million prescribed #antidepressants)
Frank, 2017 Patient Outcomes in Dose Reduction or Discontinuation of Long-Term Opioid Therapy... acpjournals.org/doi/full/10.73…
acpjournals.org/doi/full/10.73…
"Opioid tapering can be challenging for both patients & clinicians. In routine practice, discontinuation of LTOT is uncommon...from 8% to 35%....nearly half reported wanting to cut down or stop, yet 80% were receiving high-dose opioids 1 year later."
acpjournals.org/doi/full/10.73…
"There is little evidence to guide clinicians in the process of opioid tapering, especially in primary care settings, where most opioid therapy is prescribed....little is known about the risks and benefits of opioid tapering."
acpjournals.org/doi/full/10.73…
"Potential risks [of tapering] include withdrawal symptoms, increased pain....However, some patients report improvements in function & quality of life after tapering....effects of opioid tapering on patient outcomes have not been systematically reviewed."
acpjournals.org/doi/full/10.73…
"We identified 40 studies that examined the effect of dose reduction or discontinuation of LTOT on patient outcomes (key question 2). These studies included 5 randomized controlled trials....None of the 40 studies were rated as good-quality."
acpjournals.org/doi/full/10.73…
"This systematic review highlights challenges.... measurement & reporting of opioid dose reduction were heterogeneous across studies, & consensus on what constitutes meaningful dose reduction is needed, including patients transitioning to buprenorphine."
acpjournals.org/doi/full/10.73…
"Finally, this review found insufficient evidence on adverse events related to opioid tapering, such as accidental overdose if patients resume use of high-dose opioids or...illicit opioid sources or onset of suicidality or other mental health symptoms."
acpjournals.org/doi/full/10.73…
Not a word about actual tapering process. Nobody knows anything about tapering opioids, #antidepressants, other #psychiatric drugs, or any psychotropics -- except the patient-run peer support Web sites.
How much could gradual tapering improve outcomes?
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