#Opioid tapering is "extremely difficult" for people w/ #ChronicPain, "not only in those w/ problematic opioid use."
Kurita: Worsened pain &/or function led more than half of those studied to stop scheduled dose reduction of 10% or 20% per week. /thread onlinelibrary.wiley.com/doi/full/10.10…
1b/ Kurita: Altho 40 of 75 didn't complete the taper, researchers found "improvements after opioid treatment stabilization was achieved," suggesting stabilization (whether at a dose or at 0 dose) is a preferable goal to forcing everyone off rx #opioids.
Stopping can be fatal.
2/ Glanz: "Attempts to adhere to prescribing guidelines may lead patients to be exposed to variability in #opioid dosing." Dose variability of 30% or more increases the risk of overdose more than 300%.
Glanz et al. JAMA Network Open. 2019;2(4):e192613.
jamanetwork.com/journals/jaman…
3/ Oliva et al BMJ 2020: Stopping rx #opioids increases the risk of death by #suicide or #OD up to 6.8 times.
2,887 #vets whose opioid med was stopped in FY2013 died of OD or suicide, 90 fewer than died on 9/11.
bmj.com/content/368/bm…
4/ Salerian: 49 patients on stable #opioid doses showed no evidence of suicidal behavior before their medicine was stopped to comply with rx guidelines. 0 died during opioid treatment.
7 died, primarily of #suicide, after discontinuation. Their average age was 46.5.
4b/ Salerian: Young age & "clinical stability prior to discontinuation" suggest “a positive correlation between the stoppage of treatment and the fatalities and the potential neuroprotective properties of #opioids.”
researchgate.net/profile/Alen_S…
5/ James et al 2019: Discontinuation of rx #opioid meds increased the risk of death 1.35 times and tripled the risk of death by overdose (2.94 times).
4.9% of discontinued patients died of overdose, while 1.75% of retained patients did so.
5b/ James JR, Scott JM, Klein JW, et al. Mortality after discontinuation of primary care–based chronic opioid therapy for pain: a retrospective cohort study. Journal of General Internal Medicine. 2019 Dec 1;34(12):2749-55. link.springer.com/article/10.100…
6/ Lin et al 2019: #VA cohort study 2010-16 found that as the number of #opioid prescriptions went down, the number of overdose deaths went up, a finding that holds true in the civilian population, as well.
6b/
Lin LA, Peltzman T, McCarthy JF, Oliva EM, Trafton JA, Bohnert AS. Changing trends in opioid overdose deaths and prescription opioid receipt among veterans. American Journal of Preventive Medicine. 2019 Jul 1;57(1):106-10.
sciencedirect.com/science/articl…
7/ McPherson: Tapering & stopping #opioid meds put people at higher risk for heroin use, OD, suicide, & disengagement from medical care. Physicians should consider these factors when weighing “risks & benefits to individual patients" of stopping treatment.
7b/ McPherson S, Smith CL, Dobscha SK, Morasco BJ, Demidenko MI, Meath TH, Lovejoy TI. Changes in pain intensity after discontinuation of long-term opioid therapy for chronic noncancer pain. Pain. 2018 Oct;159(10):2097.
ncbi.nlm.nih.gov/pmc/articles/P…
8/ Demidenko et al 2017: #Vets whose #opioid med was stopped had 2.4 times the rate of Suicidal ideation and 6 times the risk of self-harm when compared to a community sample of vets.
suicideinfo.ca/wp-content/upl…
9/ In its 2016 Rx #Opioid Guideline, @CDCgov made "excessive use of strong recommendations in the face of low-quality evidence" (Busse).
There's no doubt the widespread, rapid, & often non-consensual rx #opioid tapers & discontinuations CDC occasioned are killing people.
9b/ Busse JW, Juurlink D, Guyatt GH. Addressing the limitations of the #CDC guideline for prescribing #opioids for chronic noncancer pain. CMAJ. 2016 Dec 6;188(17-18):1210-1. ncbi.nlm.nih.gov/pmc/articles/P…
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