Discontinuation of opioid remedy for discomfort might boost the risk of overdose in people.
Opioid-associated overdose has develop into a significant contributor to accidental deaths in the United States and Canada. A new analyze not long ago released in the journal PLOS Drugs, led by Mary Clare Kennedy of the University of British Columbia, Kelowna, Canada, signifies that halting recommended opioids may perhaps raise the possibility of overdose.
In an exertion to minimize opioid-related ailment and death, Canada and the United States have recognized guidelines to limit opioid prescriptions for continual pain. Nevertheless, the effects of discontinuing opioid therapies on overdose possibility remains mostly unstudied. To look into the connection between discontinuing prescribed opioid treatment for suffering and overdose risk, a crew of scientists performed a retrospective cohort analyze of people today getting extensive-expression opioid therapy for soreness in British Columbia in between October 2014 and June 2018. They analyzed the health-related information of 14,037 people registered with the provincial health and fitness insurance policies client roster in British Columbia who experienced been on opioid remedy for at least 90 days.
The researchers observed that discontinuing opioid treatment for pain was connected with enhanced overdose chance between men and women with no opioid use condition (OUD). However the association was more robust in these with OUD, including individuals not acquiring opioid agonist treatment (AHR = 3.18 95% CI = 1.87 – 5.40, p<0.001) and receiving opioid agonist therapy (AHR = 2.52 95% CI = 1.68 – 3.78, p<0.001). Finally, tapering opioid therapy was associated with decreased risk of overdose in those with OUD who had not received opioid agonist therapy (AHR = 0.31, 95% CI = 0.14 – 0.67, p=0.003).
The study had several limitations as the outcome measure did not capture overdose events that did not involve a healthcare encounter or result in death. Additionally, the researchers were unable to determine the source of the drugs involved in overdoses and whether they were prescribed or obtained illicitly.
According to the authors, “These findings point to the need to avoid abrupt discontinuation of opioid treatment for pain and to enhance guidance for prescribers in modifying opioid treatment tapering strategies on the basis of opioid use disorder and opioid agonist therapy status.”
Kennedy adds, “Given the increased risk of overdose, sudden discontinuation of opioid treatment for chronic pain should be avoided in almost all instances. Enhanced guidance is needed to support prescribers in implementing safe and effective opioid for pain tapering strategies, with particular consideration of opioid use disorder and prescribed opioid agonist therapy status.”
Reference: “Discontinuation and tapering of prescribed opioids and risk of overdose among people on long-term opioid therapy for pain with and without opioid use disorder in British Columbia, Canada: A retrospective cohort study” by Mary Clare Kennedy, Alexis Crabtree, Seonaid Nolan, Wing Yin Mok, Zishan Cui, Mei Chong, Amanda Slaunwhite and Lianping Ti, 1 December 2022, PLOS Medicine.
This study was funded by a Canadian Institutes of Health Research Project Grant. SN is supported by the Michael Smith Foundation for Health Research and the University of British Columbia’s Steven Diamond Professorship in Addiction Care Innovation. LT is supported by a Michael Smith Foundation for Health Research Scholar Award. The funders had no role in study design, data collection, and analysis, decision to publish, or preparation of the manuscript.
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