Published June 13, 2022
This study is a continuation to the August 2021 study Association of Dose Tapering With Overdose or Mental Health Crisis Among Patients Prescribed Long-term Opioids that found opioid dose tapering was associated with overdose and mental health crisis. This study extended the follow up period to two years and found almost identical results that opioid dose tapering is associated with increased rates of overdose, withdrawal, and mental health crisis extending up to two years after taper initiation.
The study included 19,377 U.S. adults who underwent opioid dose tapering between 2008 to 2017 after a 12-month baseline period of stable daily dosing. They were followed for two years post taper initiation.
Opioid tapering was associated with a 57% higher rate of overdose or withdrawal in the 2 years following the start of the taper, vs the year before the taper. Researchers also found a 40% higher rate of overdose and a 52% higher rate of mental health crisis.
Researchers had hypothesized that “although patients may struggle during the tapering period, we reasoned that many may stabilize with longer-term follow-up and have lower rates of overdose and mental health crisis once a lower opioid dose is achieved.” The results did not bear that out, and researchers were surprised at the outcome.
It’s clear that this study intended to show that opioid tapering was safe, and the researchers are unable to hide their bias, as teh conclusion states:
In this cohort study using an exposure-crossover analysis that controls for between-person effects, opioid dose tapering was associated with persistently elevated risk of overdose, withdrawal, and mental health crisis up to 24 months after taper initiation. Given the observational study design, we cannot infer a causal connection between tapering and long-term risks of these events. Nevertheless, our findings support guidelines advising careful monitoring and psychosocial support for patients undergoing opioid dose reduction and suggest that this support continue for at least 2 years after taper initiation, particularly among patients who were prescribed higher baseline doses.
I mean, WHAT? ‘our findings support guidelines advising careful monitoring and psychosocial support…’?
People living with severe, daily pain, the kind of chronic pain that opioids are prescribed for do not need ‘psychosocial supports and monitoring’. They need pain relief. Opioids provide safe, effective pain relief. This study SHOULD have concluded that opioid tapers should NOT be undertaken if there is no reason to do so. And the only reason to do so are patient choice, or if the patient is in imminent danger.
Since I started reading studies, I’ve found so often that conclusions don’t say what the study said, or just highlight they bits they want to turn into a media soundbite.
It’s bias.
I’ve learned that science is not the impartial, reliable ‘evidence’ that I believed it was. I believed scientists were above their human biases, but clearly, many are not. OR there is money in a certain finding…so even if the research doesn’t support a conclusion, cherry-picking and careful word choice can provide the implication that it does.
Sad. But I recommend, where possible, people always read the full study. But unfortunately, no one has time for that. GPs least of all. S they continue to believe that opioid tapering is the best course of action for people living with severe pain.
