A study published in the prestigious medical journal JAMA in 2018 provides hope about a strategy to help patients reduce their reliance on opioids. Here is a summary of the research findings and why they are so important.
Researchers at Stanford University School of Medicine wanted to find a cost-effective way to help patients reduce their opioid dose. Current opioid reduction strategies are expensive and often unavailable, because they require treatment teams that include doctors and mental health professionals. The researchers decided to develop a strategy that works in outpatient clinics that don’t have mental health services.
The 51 patients in this 4-month study had chronic pain that was not caused by cancer. They were not receiving treatment for mental health conditions or a substance use disorder. The average age was 51-years-old, and 60% of patients were women.
Patients were given one-on-one care by their physician and a self-help book about how to reduce opioid use. The physicians encouraged them to lower their daily dose or opioids gradually over four months. Researchers monitored the change in patients’ daily dose and their level of pain.
After 4 months, the average daily opioid dose decreased by almost half, from 288 milligrams to 150 milligrams. Some patients reduced their opioid dose by even more! Most patients reported that these reductions did not cause an increase in pain or in pain that was disrupting their lives.
Some of the patients were more successful than others at reducing their opioid use, but most patients had some success. Researchers did not find any factors that predicted who would be most successful. For example, patients’ opioid dose and pain level at the beginning of the study did not predict reducing opioid dose by more than half. Neither did the number of years that they had taken opioids.
What can we learn from this study? It shows that it is possible to help patients who are taking daily opioids to reduce their opioid dose in a community pain clinic with one doctor’s help and a self-help book. It can work even for patients who have been taking a high opioid dose for a long time. Rather than using drug treatment or innovative technology, physicians were successful at helping patients by providing information, guiding reductions in their doses, and closely monitoring their progress.
Although these results are promising, there are limits to what they mean in the real world. For example, patients in this study were seen in one particular outpatient clinic, so we don’t know how well this strategy would work in other settings. Also, patients volunteered for this study, which means that they were motivated to reduce their opioid dose. Because there are limits (all studies have them!), we should be careful about the conclusions we make. We can’t assume that this strategy will work for all patients using opioids. Finally, we don’t know whether this can continue to work after 4 months or if patients will find it difficult to keep up their success.
This treatment strategy should be tested at other clinics to see if it is useful for other physicians and patients to slowly reduce opioid use. If it is found to be effective in more clinics, it is a promising strategy for patients who are already addicted.
All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.
- Darnall, B. D., Ziadni, M. S., Stieg, R. L., Mackey, I. G., Kao, M. C., & Flood, P. (2018). Patient-Centered Prescription Opioid Tapering in Community Outpatients With Chronic Pain. JAMA Internal Medicine.