Discontinuing opioid therapy for pain may increase the risk of overdose in patients.
Opioid-related overdoses have become a major contributor to accidental deaths in the United States and Canada. A new study recently published in the journal PLOS medicineLed by Marie Claire Kennedy University of British Columbiakelowna, canada indicates that stopping prescribed opioids may increase the risk of overdose.
In an effort to reduce opioid-related deaths and illnesses, Canada and the United States have established guidelines to reduce opioid prescriptions for chronic pain. However, the effect of discontinuing opioid therapies on overdose risk remains largely unstudied. To investigate the relationship between discontinuing prescribed opioid treatment for pain and risk of overdose, a team of researchers conducted a retrospective cohort study of individuals receiving long-term opioid treatment for pain in British Columbia between October 2014 and June 2018. They examined medical records for pain. 14,037 patients were enrolled in the British Columbia Provincial Health Insurance client list who had been receiving opioid treatment for at least 90 days.
Researchers found that discontinuing opioid treatment for pain was associated with an increased risk of overdose among people without opioid use disorder (OUD). However, the association was strongest in those with OUD, including those not receiving opioid agonist treatment (AHR = 3.18; 95% CI = 1.87–5.40, p < 0.001) and receiving opioid treatment (AHR = 2.52; 95). %CI = 1.68 - 3.78, p < 0.001). Finally, reducing opioid treatment was associated with a reduced risk of overdose in those with OUD who did not receive opioid agonist treatment (AHR = 0.31, 95% CI = 0.14–0.67, p = 0.003).
The study had several limitations because the outcome measure did not capture overdose events that did not involve a healthcare encounter or lead to death. Additionally, the researchers were unable to determine the source of the drugs implicated in the overdose and whether they were prescribed or obtained illegally.
According to the authors, “These findings suggest the need to avoid abrupt discontinuation of opioid treatment for pain and to enhance guidance for prescribers in adjusting opioid treatment strategies based on opioid use disorder and opioid treatment status.”
Kennedy adds: “Because of the increased risk of overdose, abrupt discontinuation of opioid treatment for chronic pain should be avoided in almost all cases. Improved guidance is needed to support prescribers in implementing safe and effective pain reduction strategies, with special consideration for opioid use disorder and condition on opioid agonist therapy.” described”.
Reference: “Stopping and reducing prescription opioid analgesics and the risk of overdose among subjects receiving long-term opioid treatment for pain with or without opioid use disorder in British Columbia, Canada: a cohort retrospective study” by Marie Claire Kennedy, Alexis Crabtree, and Syonide Nolan, Weng Yin Mok, Zishan Cui, Mei Chong, Amanda Sloenwhite and Lianping Te December 1, 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 Stephen Diamond Professor at the University of British Columbia in innovation in addiction care. LT is supported by the Michael Smith Foundation for Health Research Scholar Award. Funders had no role in study design, data collection, analysis, publication decision, or manuscript preparation.