New UNSW report: Problem opioid behaviours are related to pre-existing risks, not dose
A new study from UNSW Sydney has analysed findings from a five-year cohort of 1514 people who have been prescribed opioids for chronic non-cancer pain, finding that risk for problematic opioid outcomes is related to a combination of patient characteristics and pre-existing factors, rather than opioid dose alone.
From the report :
““Long-term opioid use for people living with chronic non-cancer pain is common. This has traditionally been associated with concerns of increased rates of adverse harms related to opioid use, particularly dependence and overdose,” said Dr Campbell.
The report comes in response to concerns that patients with chronic non-cancer pain have been exposed to abrupt and forced tapering and cessation of opioids simply for being on a high dose – which can lead to added harms, including increased mortality – and concern that a higher dose is associated with problematic opioid behaviours. “
In short, because some GPs have misinterpreted the new opioid prescribing regulatlons, which came into effect on June 1st, some doctors have force tapered patients off their opioids PURELY because they were taking higher doses. This report shows that dose is not the issue, the risk factors for problematic opioid use are previous drug abuse and mental health issues. It goes on to say that opioids are safe and appropriate in well-screened and well monitored patients.
Importantly the report states:
“It is possible that this emphasis on dose comes from the ability to easily measure and respond to dose thresholds, compared with the relative complexity and time considerations of assessing other clinical factors that substantially contribute to opioid-related risk,” said Dr Campbell.
Essentially, doctors are time poor, and its easy to cut people off based on an arbitrary number – the daily dose. Taking a proper history and assessing the patient for previous abuse and mental health issues takes much longer, and involves much more effort.
Bottom line? Overworked GPs and pain specialists don’t want to do that work. To the great detriment of people living with high impact chronic pain, who rely on opioids for quality of life.
Read the report and let me know what you think.