- A patient-centric approach to opioid dosage tapering can reduce the need for behavioral health specialists, thus improving patient access to the often-costly process of weaning off opioid treatments, according to a research letter published in JAMA Internal Medicine.
The healthcare industry is currently facing an imperative to reduce opioid use and potential misuse. In the midst of the opioid epidemic, medical professionals are attempting to reduce prescription and use of opioids to quell potential misuse.
For patients with chronic pain, these attempts at reducing opioid prescriptions have included behavioral health counseling and opioid dosage tapering. These approaches use extensive interdisciplinary teams featuring behavioral health specialists, which can run up a high bill for patients and health payers.
Those costs make access to opioid dosage tapering inaccessible to most patients, the research team said.
“Patients and physicians need solutions to successfully reduce long-term prescription opioid dosages in settings without behavioral services,” the researchers stated. “We conducted a study of voluntary, patient-centered opioid tapering in outpatients with chronic pain without behavioral treatment.”
The intervention required patients with non-cancer-related chronic pain to deliver a set of baseline statistics such as current pain levels, opioid use converted to morphine equivalent daily dose (MEDD), marijuana use, and other measures.
For the first of the four-month intervention, patients and their prescribing provider reduced opioid dosage up to five percent for up to two dose reductions. This effort was intended to reduce withdrawal symptoms.
In the following two through four months, providers reduced dosage by up to 10 percent weekly. Reductions were dependent upon the patient and her reports of her current progress in the program.
Patient follow-ups occurred at least monthly, with patients submitting a required progress survey. Patients who did not submit all four progress surveys were deemed program non-completers.
In total, 68 patients began the program. These patients received patient education regarding the benefits of opioid reduction, as well as regular counseling from their prescribing providers. The only program exclusion was current enrollment in substance abuse disorder treatment.
Thirty-one percent of the patients who began the program did not complete the four surveys. Depression negatively correlated with study completion, while marijuana use positively correlated with study completion.
Median baseline opioid use, or MEDD, was 288 milligrams. Median pain intensity was rated at five on a 10-point scale.
At the end of the four-month program, median MEDD was 150 milligrams and median pain intensity remained unchanged.
Certain factors such as baseline opioid use or pain intensity did not influence the likelihood of a patient reducing her opioid use by at least 50 percent, the researchers found.
Opioid tapering programs do have a history of being effective, the researchers said. This most recent study suggests that opioid tapering programs can still be effective without the interdisciplinary team, making patient access to the treatment ample. When the costly factors associated with opioid tapering are cut out, patients are more likely to access the service and benefit from it.
“Our findings suggest that a substantial fraction of patients at a pain clinic may wish to engage in voluntary opioid tapering,” the researchers aid.
“Our data challenge common notions that patients taking high-dose opioids will fail outpatient opioid tapers or that duration of opioid use predicts taper success,” the team added. “Combining patient education about the benefits of opioid reduction with a plan that reduces opioids more slowly than current tapering algorithms with close clinician follow-up may help patients engage and succeed in voluntary outpatient tapering.”
The study’s shortcomings included its small sample size – the researchers only prompted patients at one community pain clinic. Going forward, the team plans to conduct the study using multiple different patient populations to determine the generalizability of the results.
However, the current outcomes are promising. As the healthcare industry continues to grapple with opioid misuse, it is important that there are affordable and accessible care options for patients. While opioids may be necessary for managing certain chronic pain cases, being able to reduce dosages in an cost-effective and efficient manner is key.