A New Study Finds That Reducing Pain Medication Is Associated With an Increased Risk of Overdose and Suicide
Substantially reducing the doses of pain medication prescribed for patients on long-term opioid therapy is associated with a threefold increase in suicide attempts and a 69 percent increase in overdoses, according to a study published this week in The Journal of the American Medical Association (JAMA). The study reinforces concerns that the “tapering” encouraged by federal guidelines as a response to the “opioid crisis” causes needless suffering among patients, leading to undertreatment of pain, withdrawal symptoms, and emotional distress.
Alicia Agnoli, an assistant professor of family and community health at the University of California, Davis, and five other researchers examined the medical records of about 114,000 patients who had been prescribed “stable, high doses of opioids,” with a mean daily dose of at least 50 morphine milligram equivalents (MMEs), for at least 12 months. They identified more than 29,000 patients whose doses were subsequently reduced by 15 percent or more. They used hospital records to identify “overdose or withdrawal events” and “mental health crisis events,” including depression or anxiety and suicide attempts, during follow-up periods of up to a year.
“Posttapering patient periods were associated with an adjusted incidence rate of 9.3 overdose events per 100 person-years compared with 5.5 events per 100 person-years in nontapered periods,” Agnoli et al. report. “Tapering was associated with an adjusted incidence rate of 7.6 mental health crisis events per 100 person-years compared with 3.3 events per 100 person-years among nontapered periods.” In other words, tapering was associated with a 69 percent increase in overdose events and a 130 percent increase in mental health crisis events. Suicide attempts were 3.3 times as likely when patients’ doses were tapered.
It is hardly surprising that patients who had been receiving stable doses of opioids for an extended period of time—doses that presumably controlled their pain effectively enough that they could function reasonably well—would experience distress when their doctors suddenly decreed that they would have to get by with less medication. The results of this study are consistent with earlier research documenting the danger of such one-sided, politically driven decisions. A 2020 study of veterans found that “patients were at greater risk of death from overdose or suicide after stopping opioid treatment.” Another study published last year found that discontinuation of opioid therapy was associated with an increased risk of heroin use.
The JAMA study is also consistent with numerous complaints from pain patients across the country who reported that their medication was arbitrarily reduced or cut off in response to the prescribing guidelines that the Centers for Disease Control and Prevention (CDC) published in 2016. As Agnoli and her co-authors note, the CDC “recommended against higher doses of opioids in managing chronic pain and recommended dose tapering when harms of continued therapy outweigh per
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