Patients who take opioid pain killers of varying doses over time are three times more likely to overdose than patients who are kept on the same dose. This is according to an observational study from Kaiser Permanente which also found that when patients discontinued long-term opioid therapy for three or more months, they had had half the risk of overdosing.
"Our study suggests that safely managing long-term opioid therapy is complex," said Ingrid Binswanger, MD, senior investigator at Kaiser Permanente Institute for Health Research in Colorado and co-author of the study in a statement.
Published in JAMA Network Open, the 12-year study focused on 14,000-plus Kaiser Permanente members in Colorado who were taking prescribed long-term opioids. Electronic health records were used to track patient history and determine dose changes and overdoses from opioid pain medications and other opioid drugs.
"This study suggests going up and down on opioid doses — also called dose variability — could present an increased risk of overdose," said Dr. Binswanger, whose study was funded by the National Institute on Drug Abuse. "Through this study, we also found eventually discontinuing opioid therapy may prevent overdoses. With continued studies, we hope to find out how care providers can help patients with their pain without putting them at unnecessary risk due to rapid changes in their dose."
Meanwhile, the Food and Drug Administration in early April announced changes will have to be made to the prescribing information labels for opioid medication intended for use in the outpatient setting. These changes will provide expanded guidance to healthcare professionals on how to safely decrease the dose in patients who are physically dependent on opioid pain medicines when the dose is to be decreased or the medicine is to be discontinued.
The National Institutes for Health has granted another $2 million, 4-year grant to follow up on findings and identify how patients and doctors manage changes in opioid doses, including any long-term risks and benefits of discontinuing opioid pain medications.
