Association of Opioid Dose Reduction With Opioid Overdose and Opioid Use Disorder Among Patients Receiving High-Dose, Long-term Opioid Therapy in North Carolina

DiPrete, Bethany L.; Ranapurwala, Shabbar I.; Maierhofer, Courtney; Fulcher, Naoko; Chelminski, Paul R.; Ringwalt, Christopher L.; Ives, Timothy J.; Dasgupta, Nabarun; Go, Vivian F.; Pence, Brian W.

doi:10.1001/jamanetworkopen.2022.9191

Cited by 38 publications

(37 citation statements)

References 41 publications

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“…Abruptly discontinuing opioids after long-term use has been shown to increase illicit substance use, emergency department visits, and deaths from overdose or suicide. [115][116][117] As a result, tapering opioid therapy must be conducted slowly, engaging patients throughout the process. 118 As many patients for whom guideline recommendations apply present with MCC, any treatment plan needs to account for the complexity and uncertainty created by the presence of MCC and highlight the importance of shared decision making regarding guideline use and implementation.…”

Section: Multiple Chronic Conditionsmentioning

confidence: 99%

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Use of Opioids for Adults With Pain From Cancer or Cancer Treatment: ASCO Guideline

Paice

Bohlke

Barton

et al. 2023

JCO

100

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PURPOSE To provide guidance on the use of opioids to manage pain from cancer or cancer treatment in adults. METHODS A systematic review of the literature identified systematic reviews and randomized controlled trials of the efficacy and safety of opioid analgesics in people with cancer, approaches to opioid initiation and titration, and the prevention and management of opioid adverse events. PubMed and the Cochrane Library were searched from January 1, 2010, to February 17, 2022. American Society of Clinical Oncology convened an Expert Panel to review the evidence and formulate recommendations. RESULTS The evidence base consisted of 31 systematic reviews and 16 randomized controlled trials. Opioids have primarily been evaluated in patients with moderate-to-severe cancer pain, and they effectively reduce pain in this population, with well-characterized adverse effects. Evidence was limited for several of the questions of interest, and the Expert Panel relied on consensus for these recommendations or noted that no recommendation could be made at this time. RECOMMENDATIONS Opioids should be offered to patients with moderate-to-severe pain related to cancer or active cancer treatment unless contraindicated. Opioids should be initiated PRN (as needed) at the lowest possible dose to achieve acceptable analgesia and patient goals, with early assessment and frequent titration. For patients with a substance use disorder, clinicians should collaborate with a palliative care, pain, and/or substance use disorder specialist to determine the optimal approach to pain management. Opioid adverse effects should be monitored, and strategies are provided for prevention and management. Additional information is available at www.asco.org/supportive-care-guidelines .

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Section: Multiple Chronic Conditionsmentioning

confidence: 99%

“…Abruptly discontinuing opioids after long-term use has been shown to increase illicit substance use, emergency department visits, and deaths from overdose or suicide. 115-117 As a result, tapering opioid therapy must be conducted slowly, engaging patients throughout the process. 118…”

Section: Multiple Chronic Conditionsmentioning

confidence: 99%

Use of Opioids for Adults With Pain From Cancer or Cancer Treatment: ASCO Guideline

Paice

Bohlke

Barton

et al. 2023

JCO

100

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“…Bethany L. DiPrete, PhD, and colleagues found that staying on long-term, high-dose opioid therapy, ironically, was safer than tapering gradually or rapidly over a four-year period. (See DiPrete et al, 2022.) Slow tapering was safer than rapid tapering but not as safe as remaining on high-dose opioid therapy.…”

mentioning

confidence: 99%

Continuing Warning Signals About the Hazards of Opioid Tapering

2023

The Back Letter

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Contents ofThe Back Letter ® are protected by copyright. Reproduction, photocopying, and storage or transmission by magnetic or electronic means are strictly prohibited. Violation of copyright will result in legal action, including civil and/or criminal penalties. Permission to reproduce must be secured in writing; go to the newsletter website (www.backletter.com), select the article, and click "Request Permissions" under "Article Tools," or e-mail

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“…The National Institutes of Health and other research sponsors must allocate funding toward the development of safer analgesics, nonpharmacologic pain management strategies, and more comprehensive long-term clinical studies, 15 including patient outcomes after both initiation and discontinuation of existing pharmacotherapies. 16 Expanding support for the National Institutes of Health Helping to End Addiction Long-term (HEAL) Initiative is one way to achieve this goal. Supporting research and development from small- and medium-size companies, in the form of tax credits or public–private partnerships, must be prioritized.…”

mentioning

confidence: 99%