Discontinuation of chronic opioid therapy is associated with an increased risk of overdose death, according to a study published in the Journal of General Internal Medicine.
“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 Jocelyn James, MD, University of Washington School of Medicine, Seattle, Washington. “We have to make sure we develop systems to protect patients.”
Physicians had already begun to reduce opioid prescribing by 2016, when the Centers for Disease Control and Prevention issued its first guideline on opioid prescribing. That trend continued to accelerate after 2016.
While reduced prescribing may be intended to improve patient safety, little is known about the real world benefits or risks of this sea change in opioid prescribing.
For the current study, Dr. James and colleagues 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, 20.8% of the registry patients died and 3.7% of the patients died of a definitive or possible overdose — 4.9% had discontinued chronic opioid therapy and 1.75% were patients being seen at a clinic.
After adjusting for age and race, discontinuation of chronic opioid therapy was associated with a hazard ratio for death of 1.35 (95% confidence interval [CI], 0.92-1.98; P = .122) and a hazard ratio for overdose death of 2.94 (95% CI, 1.01-8.61; P = .049).
“Improved clinical strategies, including multimodal pain management and treatment of opioid use disorder, may be needed for this high-risk group,” the authors concluded.