For millions on long-term opioid medications, change will be a challenge

A team of researchers at the University of Colorado School of Medicine and the VA Eastern Colorado Health Care System recently surveyed patients to understand barriers to reducing the use of opioids to manage chronic pain. The results of those interviews are published in the current issue of the journal Pain Medicine.

Millions of Americans take opioid medications daily to manage chronic pain, but there are growing concerns among health care professionals of opioid misuse and overdose. In early 2016, the Centers for Disease Control and Prevention issued new guidelines, emphasizing a conservative approach to opioid prescribing. For patients already on long-term opioid medications, the transition away from opioid medications can be intensely unpleasant, anxiety-provoking and complex, according to the study.

The research team at the CU School of Medicine and the VA Eastern Colorado Health Care System conducted in-depth interviews of 24 patients across 3 health systems in metro Denver to explore the perspectives of patients on this issue. Participants in the study described experiences of decreasing or stopping opioid medications that were complicated by opioid withdrawal symptoms, fears of increased pain and confusing medication changes. However, study participants also described an improved quality of life after the transition.

"While the process can be very challenging, there may be a silver lining here," said Joseph Frank, MD, MPH, assistant professor of medicine and a primary care physician at the VA Medical Center in Denver. "We heard powerful stories of patients reclaiming their lives. It will be important to ensure that patients' voices are heard in the national conversation about these medications."

Study participants also highlighted the importance of support from family and from healthcare providers. This level of intensive support may be difficult for some outpatient primary care practices, where a majority of opioid medications are prescribed. "To achieve goals of improving quality of life and preventing opioid-related harms, we need better evidence and more resources to support patients both during and after this challenging transition," Frank said.