Researchers find alarming risk for people coming off chronic opioid prescriptions

With a huge push to reduce opioid prescribing, little is known about the real-world benefits or risks to patients.

A recent study published in the Journal of General Internal Medicine found an alarming outcome: Patients coming off opioids for pain were three times more likely to die of an overdose in the years that followed.

"We are worried by these results, because they suggest that the policy recommendations intended to make opioid prescribing safer are not working as intended," said lead author Jocelyn James, assistant professor of general internal medicine at the University of Washington School of Medicine. "We have to make sure we develop systems to protect patients."

Physicians had already begun to reduce opioid prescribing by 2016, when the CDC issued its first guideline on opioid prescribing. That trend accelerated after 2016.

While reduced prescribing may well be intended to improve patient safety, little is known about the real world benefits or risks of this sea change in opioid prescribing.

The study looked at a cohort of 572 patients with chronic pain enrolled in an opioid registry. Chronic opioid therapy was discontinued in 344 patients and 187 continued to visit a primary care clinic. During the study period, 119 registry patients died (20.8%); 21 patients died of a definitive or possible overdose—17 were discontinued patients and four were patients being seen at a clinic.

As the researchers concluded: "Discontinuing chronic opioid therapy was associated with increased risk of death."

Researchers said that improved clinical strategies, including multimodal pain management and treatment of opioid-use disorder, may be needed for this high-risk group.

At the time of this study, state rules did not allow medication treatment of opioid-use disorder in the primary care setting, said co-author Joseph Merrill, professor of general internal medicine at the University of Washington School of Medicine.

But after those rules changed, he said the addiction clinic at Harborview has developed a strong program to provide medication treatment for opioid-use disorder, including those who develop problems related to prescription pain medication.

"We hope these findings encourage others who prescribe opioids to do the same," Merrill said.

Researchers said the UW Medicine study is the third study published this year to look at the risks of stopping opioids:

• A study published in the Journal of Substance Abuse Treatment found that among patients at high dose who stopped opioids, almost half had their doses reduced to 0 in a single day and many wound up in emergency departments.
• A New York study in the Journal of General Internal Medicine found that ending opioid prescriptions was often followed by an end to the care relationship.
• This spring the United States Food and Drug Administration issued a warning that suddenly stopping opioids can present a risk to patients.