Increased risk after discontinuation of analgesics

Researchers conducted a cohort study of people taking long-term opioid therapy for pain in British Columbia between October 2014 and June 2018.

They examined the medical histories of 14,037 people on the provincial health insurance directory of British Columbia who had been on opioid therapy for at least 90 days.

The team reported that discontinuation of opioid therapy for pain was associated with an increased risk of overdose in people without opioid use disorders. The overdose is even more likely for people with disabilities, including those without.

Patients who received tapered opioid therapy had a reduced risk of overdose in patients with opioid use disorders who did not receive opioid agonist therapy.

opioid agonist therapy Medications such as methadone are used to help manage withdrawal symptoms.

The authors noted that their study had several limitations, including the fact that outcome measures did not capture overdose events without medical intervention or events leading to death. It is included.

Researchers also said they were unable to determine the source of the drugs involved in the overdose, or whether they were prescribed or obtained illegally.

“These findings warrant increased guidance to prescribers in avoiding abrupt discontinuation of opioid therapy for pain and in modifying opioid therapy tapering strategies based on opioid use disorders and opioid agonist therapy status.” ,” the authors of the study wrote.

“Given the increased risk of overdose, abrupt discontinuation of opioid treatment for chronic pain should be avoided in almost all cases,” the study authors added. “Increased guidance is needed to support prescribers in implementing safe and effective opioids for pain reduction strategies, especially given the status of opioid use disorders and prescribed opioid agonist therapy. is.”

AS Dr. Josef VolpicelliHe is executive director of the Volpicelli Institute of Addiction Medicine in Pennsylvania.

“Around 2010, the alarming rise in opioid overdoses caused a rethinking of the medical use of opioids to treat pain, causing the pendulum to swing in the opposite direction.” We have become increasingly reluctant to use opioids to treat and often find that behavioral therapy and non-opioid medications can effectively relieve pain.”

When doctors started cutting off prescriptions, they may have underestimated what happened next. The user experienced severe withdrawal symptoms and turned to street drugs such as heroin instead of prescription drugs.

“In 2010, there were 81 opioid prescriptions per 100 people, but this has dropped dramatically over the decade to 43 prescriptions per 100 people,” Volpicelli said. “By 2015, deaths from prescription opioids stopped rising, but deaths from heroin overdoses increased dramatically.”

“We are now in the third wave of the opioid overdose epidemic as the highly potent and dangerous synthetic opioid fentanyl has replaced prescription opioids and heroin as the leading illicit opioid,” Volplicelli said. said.

The big question now is when will opioids go from being safely prescribed to being a problem of addiction?

“Every patient is different and has different needs.” Farrah Corassani PharmD, a physician in pharmacology and associate clinical professor at the University of California, Irvine, told Healthline.

“Repeated doses of opioids can cause dependence, which occurs in different people at different times, depending on diagnosis, psychological conditioning, environment, and neurobiological factors.

Experts say tolerance to the drug increases with use, requiring higher doses and making quitting more difficult. Unexpected effects when used again.

“Once a person detoxifies from opioids, many people don’t realize they can’t tolerate the same amount they did before they stopped,” Corassani said. It can lead to overdose where suppression is seen.”

Another issue is how long a prescription should last before the danger of addiction arises.

“7 days to 21 days is a good time frame for someone to take an opiate for the purpose of relieving acute pain. James S. Platyis a psychologist specializing in addiction medicine and the medical director of behavioral health at Brand New Day Healthcare.

“Hopefully, during that time, the doctor was instructing the patient to gradually reduce the frequency of taking the opiate from day 7 to day 21.” Other interventions such as therapy, yoga and trigger point injections are better interventions for chronic pain problems.”

Aaron Weiner He is an addiction psychologist and president of the Society of Addiction Psychology. He told Healthline that the most important key to avoiding opiate addiction is recognizing the signs and symptoms and getting in touch with your doctor.

“If you develop a mild chemical addiction to opioids, the good news is that under the guidance of your doctor, you can slowly taper off the drug and avoid very bad consequences.

“There are now many treatments and medications that may help if regular tapers don’t work,” he added. , access to these resources: trying to hide your dependencies from your health care team can make your road to recovery much steeper if your dependencies grow and worsen. It has many negative effects on