Managing opioid withdrawal is a complicated process.
Research from the University of California – UC Davis - recently published in JAMA[i], describes just how complicated.
The study looked at 113,618 patients prescribed stable higher opioid doses (the equivalent of at least 50 morphine milligrams per day) for a year.
The research team from UC Davis looked at the difference between patients who underwent opioid dose tapering during the trial period and those who had not yet started tapering to understand the difference between the two groups.
They reviewed emergency department visits and inpatient hospital admissions for information on any drug overdose or alcohol intoxication. They also examined the records looking for mental health crisis events such as depression, anxiety, or suicide attempts.
Incredibly, they found a 68% increase in overdose events and a doubling of mental health crises among the patients undergoing tapering compared to those on a stable dose.
On publishing their result, the study authors emphasized the need for clinicians and patients to carefully weigh the benefits and risks of opioid dose tapering before tapering is attempted.
The Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC) both strongly recommend a similar approach.
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[i] Alicia Agnoli, Guibo Xing, Daniel J. Tancredi, Elizabeth Magnan, Anthony Jerant, Joshua J. Fenton. Association of Dose Tapering With Overdose or Mental Health Crisis Among Patients Prescribed Long-term Opioids. JAMA, 2021; 326