In Australia, opioid tapering has become commonplace since the regulations around opioid prescribing changed in June 2020. Many GPs and pain specialists have undertaken forced opioid tapering, either reducing opioid doses to less than 100 milligrams of morphine equivalent (MME) leaving the patient’s pain under treated or even tapering off opioids completely.
This was a simplistic, knee-jerk reaction to the ever-increasing vigilance by the health departments, with many GPs fearful that their prescribing was being monitored or could be restricted. In 2018 the health department sent letters to the GPs in the top 20% of prescribers, to try and curtail opioid prescribing. The problem was most of these prescribers were prescribing opioid for end-of-life care and the prescriptions were completely appropriate. The government did not bother to check the validity of the prescriptions.
Still, the damage was done. For many GPs, the simplest solution was to taper all their patients off their opioid pain medications. This was NOT the best thing for the patients, but the best for the GPs.
Now, the evidence clearly shows what chronic pain patients on long term opioid therapy knew all along: tapering opioids causes increased pain, increased distress, lower quality of life, lower function, higher utilisation of ERs and other health services, and significantly increased risk of overdose and death.
The evidence is summarised below:
2023
Study – Association Between Opioid Tapering and Subsequent Health Care Use, Medication Adherence, and Chronic Condition Control
This retrospective cohort study found that forced opioid tapering results in increased emergency department visits and hospitalisation, and fewer primary care visits. Forced tapering fractures the primary care relationship, leaving people who rely on long term opioid therapy without care, and no choice but to utilise higher cost hospital care. In addition, people who are force tapered experience poorer chronic disease control (diabetes and hypertension).
Key Takeaway? This study does NOT support the assertion that tapering opioids leads to improved quality of life. INFACT tapering leads to poorer health outcomes, poorer chronic disease control and loss of primary care and higher utilisation of the emergency department and hospital care.
2022
Study – Long-term Risk of Overdose or Mental Health Crisis After Opioid Dose Tapering
This study continued the work fo the 2021 study and found the same results – that opioid tapering increases the risk of overdose, suicide and mental heath crisis. The new finding is that the risk persists for two years.
Key Takeaway? This study does NOT support the assertion that tapering opioids leads to improved quality of life and that tapering does not increase pain. INFACT tapering leads to increased pain and overdose deaths and suicides.
2021
Study – Association of Dose Tapering With Overdose or Mental Health Crisis Among Patients Prescribed Long-term Opioids
This study is damning. It created quite the furore when it was published, not least because it , proved what the International stakeholder community of pain management experts had warned about, two years earlier – that pain patients on long term opioid therapy were suffering severe harms, including overdose, mental health crisis, suicide and death, due to being force tapered off their safe and effective opioid pain medications.
Key Takeaway? This study does NOT support the assertion that tapering opioids leads to improved quality of life and that tapering does not increase pain. INFACT tapering leads to increased pain and overdose deaths and suicides.
Study – “I felt like I had a scarlet letter”: Recurring experiences of structural stigma surrounding opioid tapering among patients with chronic, non-cancer pain
This study found that opioid tapering leads to patients on long term opioid therapy feeling highly stigmatised, treated like ‘drug seekers’, forced to submit to pill counts and drug testing, and experiencing feelings of depression and abandonment by society and the medical fraternity. The study illustrates how and why chronic pain patients who have been force tapered become suicidal or turn to street drugs, leading to overdose.
Key Takeaway? This study does NOT support the assertion that tapering opioids leads to improved quality of life.
2018
Study – International Stakeholder Community of Pain Experts and Leaders Call for an Urgent Action on Forced Opioid Tapering
This is not so much a study, as an international consortium of high-profile pain management experts – physicians, psychologists, psychiatrists, pharmacists protesting the forced taper of chronic pain patients in the US post 2016 CDC opioid prescribing guidelines. They outline the significant harms and demand patient centred, compassionate care to stop the overdoses and suicides that tapering was causing.
Key Takeaway? This study does NOT support the assertion that tapering opioids leads to improved quality of life and that tapering does not increase pain. INFACT tapering leads to increased pain and overdose deaths and suicides.
Study – Does Opioid Tapering in Chronic Pain Patients Result in Improved Pain or Same Pain vs Increased Pain at Taper Completion? A Structured Evidence-Based Systematic Review
The study found that opioid tapering does not lead to increased pain BUT the studies were over low to very low-quality evidence and the conclusion was that high quality research needs to be undertaken to answer this question.
Key Takeaway? This study does NOT support the assertion that tapering opioids does not lead to increased pain.
