Discontinuation of opioid remedy for ache could enhance the chance of overdose in sufferers.
Opioid-related overdose has turn into a significant contributor to unintentional deaths in america and Canada. A brand new examine just lately printed within the journal PLOS Medication, led by Mary Clare Kennedy of the College of British Columbia, Kelowna, Canada, signifies that stopping prescribed opioids could enhance the chance of overdose.
In an effort to lower opioid-related sickness and demise, Canada and america have established tips to restrict opioid prescriptions for persistent ache. Nevertheless, the impression of discontinuing opioid therapies on overdose danger stays largely unstudied. To research the connection between discontinuing prescribed opioid remedy for ache and overdose danger, a staff of researchers carried out a retrospective cohort examine of people receiving long-term opioid remedy for ache in British Columbia between October 2014 and June 2018. They studied the medical information of 14,037 sufferers registered with the provincial medical health insurance consumer roster in British Columbia who had been on opioid remedy for not less than 90 days.
The researchers discovered that discontinuing opioid remedy for ache was related to elevated overdose danger amongst individuals with out opioid use dysfunction (OUD). But the affiliation was stronger in these with OUD, together with these not receiving opioid agonist remedy (AHR = 3.18; 95% CI = 1.87 – 5.40, p<0.001) and receiving opioid agonist remedy (AHR = 2.52; 95% CI = 1.68 – 3.78, p<0.001). Lastly, tapering opioid remedy was related to decreased danger of overdose in these with OUD who had not acquired opioid agonist remedy (AHR = 0.31, 95% CI = 0.14 – 0.67, p=0.003).
The examine had a number of limitations as the result measure didn’t seize overdose occasions that didn’t contain a healthcare encounter or lead to demise. Moreover, the researchers have been unable to find out the supply of the medicine concerned in overdoses and whether or not they have been prescribed or obtained illicitly.
Based on the authors, “These findings level to the necessity to keep away from abrupt discontinuation of opioid remedy for ache and to boost steering for prescribers in modifying opioid remedy tapering methods on the premise of opioid use dysfunction and opioid agonist remedy standing.”
Kennedy provides, “Given the elevated danger of overdose, sudden discontinuation of opioid remedy for persistent ache must be averted in nearly all cases. Enhanced steering is required to help prescribers in implementing secure and efficient opioid for ache tapering methods, with explicit consideration of opioid use dysfunction and prescribed opioid agonist remedy standing.”
Reference: “Discontinuation and tapering of prescribed opioids and danger of overdose amongst individuals on long-term opioid remedy for ache with and with out opioid use dysfunction in British Columbia, Canada: A retrospective cohort examine” by Mary Clare Kennedy, Alexis Crabtree, Seonaid Nolan, Wing Yin Mok, Zishan Cui, Mei Chong, Amanda Slaunwhite and Lianping Ti, 1 December 2022, PLOS Medication.
This examine was funded by a Canadian Institutes of Well being Analysis Undertaking Grant. SN is supported by the Michael Smith Basis for Well being Analysis and the College of British Columbia’s Steven Diamond Professorship in Habit Care Innovation. LT is supported by a Michael Smith Basis for Well being Analysis Scholar Award. The funders had no position in examine design, knowledge assortment, and evaluation, determination to publish, or preparation of the manuscript.
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