Chronic-pain patients who stop taking opioids are more likely to die of an overdose than patients who stay on prescribed opioids, according to a newly published study of Harborview Medical Center patients.
The findings suggest that federal guidelines given to doctors who prescribe opioids might not be keeping patients safe, the study’s authors assert.
Further, doctors and clinics that prescribe opioids should also provide access to medications like buprenorphine, which helps people with opioid-use disorders stay off the pain medication, said one of the study’s authors, Dr. Joseph Merrill, who teaches at the University of Washington School of Medicine and works at the Adult Medicine Clinic at Harborview Medical Center.
The study, which was published Aug. 29 in the Journal of General Internal Medicine, aimed to gather information that could make prescribing opioids safer, Merrill said. It examined 572 chronic-pain patients at Harborview’s Adult Medicine Clinic who enrolled in the state’s opioid registry between 2010 and 2015. Of those, 344 stopped taking opioids during the course of the study, and 119 died. Twenty-one of the deaths were due to an overdose, and almost everyone who died of an overdose had at some point stopped treatment at the clinic.
Merrill said he was surprised at the number of people who died, given the small size of the study.
Some patients had stopped taking their prescribed opioids voluntarily, while others were taken off treatment by a doctor because their behavior put them at risk. This group largely didn’t interact with medical professionals after they stopped treatment, and it isn’t completely known which drugs the people who stopped treatment overdosed on, Merrill said.
“There was some discontinuity of care,” Merrill said. “How much of that is related, we don’t know.”
In 2016, a year after the study ended, the Centers for Disease Control and Prevention (CDC) issued its first guidelines for prescribing opioids. The guidelines focus on three areas:
- When opioids should be started or continued for patients with chronic pain.
- Opioid selection, dosage, duration and when the treatment should be discontinued.
- Assessing risk and addressing the harms of opioid use.
After analyzing the results of this study, however, Merrill said these measures, which were meant to make prescribing opioids safer, “might not have worked as well as we hoped.”
“We are worried by these results because they suggest that the policy recommendations intended to make opioid prescribing safer are not working as intended,” the study’s lead author, Dr. Jocelyn James, an assistant professor at UW Medicine, said in a statement. “We have to make sure we develop systems to protect patients.”
With the CDC guidelines in place, more needs to be known about how patients fare when taken off opioids, Merrill said. The study’s researchers wrote that, “discontinuing chronic opioid therapy was associated with increased risk of death in this observational study.”
At the time of the study, doctors weren’t allowed to treat patients coming off opioids with buprenorphine. Since then, the laws have changed. Merrill said medications that help ease patients off opioids are now used at Harborview and should be used in any clinic where people are using opioids for chronic pain.