On barriers to care:
- Two surveys found that half of primary care clinics are unwilling to take on a new patient who uses opioids to manage pain.
- The original study is of clinics in Michigan (Lagisetty, JAMA Netw. Open 2019).
- A follow-up study looked at primary care clinics in 9 states (Lagisetty, PAIN 2021).
Tapering poses risks:
- One study found just changing a patient’s dose resulted in a three-fold increased risk of overdose death. (Glanz, JAMA Netw. Open 2019).
- One study of Medicaid patients on opioids for more than 90 days found discontinuation often happened abruptly, in 24 hours, with almost half of such cases resulting in hospitalization or an ER visit (Mark, J Subs.t Abuse Treat. 2019).
- Tapering resulted in an increased risk of death in primary care settings (James, J Gen Intern Med 2019).
- Veterans who were tapered experienced a higher risk of death from overdose or suicide (Oliva, BMJ 2020).
- Opioid tapering is associated with later termination of care relationships (Perez, J Gen Intern Med 2020).
- Discontinuation of opioids in patients stable on opioids is on the rise and happens too abruptly (Neprash, J Gen Intern Med 2021).
- Dose tapering is associated with mental health crises and overdose events. (Agnoli, JAMA 2021).
- Higher incidence of overdose and mental health crisis continued two years post-taper. (Fenton, JAMA Open Netw. 2022).
- Heightened risk of overdose and suicide in patients without OUD/misuse risk w/ no difference in outcome btw. abrupt or slow taper. (Larochelle, JAMA Netw. Open 2022).
- Increase in emergency department visits and hospitalizations, fewer primary care visits, and lower medication adherence (diabetes, hypertension). (Magnan, JAMA Netw. Open 2023).
Voluntary tapering poses fewer risks:
- The largest study of voluntary tapering shows that where there is patient buy-in, education, and readiness to taper, and when the taper is not unidirectional, most patients reduced their dose (although not everyone, so individualization continues to matter). (Darnall, JAMA Intern Med. May 2018).