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A low-cost, community-based approach successfully helped chronic pain patients cut daily opioid use, researchers at Stanford University found.

Over 4 months, chronic pain patients who had used a median of 288 morphine milligram equivalents (MME) at baseline tapered to 150 MME, reported Beth Darnall, PhD, and co-authors in a research letter.

"To date, opioid-tapering research reports on costly and largely inaccessible inpatient programs or resource-intensive structured outpatient opioid reduction programs," Darnall told 木瓜直播. "We tested a community-based, voluntary opioid tapering approach that any prescriber can implement with limited to no resources, just some basic training in methodology."

"The best part is that patients successfully reduced opioids without increasing pain," she noted.

Nationwide, people have chronic pain according to the National Health Interview Survey (NHIS). An estimated Americans use opioids to treat chronic pain.

In 2016, the CDC published guidelines that physicians should avoid increasing daily doses to 90 MME or more for chronic pain patients. Some states recently have restricted opioid prescribing: in , for example, chronic pain patients are limited to 100 MME per day.

In this study, prescribing physicians educated chronic noncancer pain patients in a community clinic about the benefits of reducing opioid use, offering to help patients reduce doses over 4 months. Patients being treated for substance use disorder were excluded.

Of 110 eligible patients, 82 (75%) agreed to taper opioid dosages. Their average age was 51 and 60% of the group was female. They received a self-help booklet about reducing opioid use and a custom tapering program based on their individual needs.

To lessen withdrawal symptoms, physicians decreased opioid doses up to 5% for up to two dose reductions in the first month. In months 2 to 4, patients were asked to reduce doses by as much as 10% per week, with increments tailored to each patient. Physicians monitored patients with close clinical follow-up at least once a month, adjusting doses as needed.

After 4 months, researchers administered follow-up surveys. Of 82 patients, 31 did not complete the 4-month survey and were considered to have dropped out of the study. Depression negatively correlated (P=0.05) and baseline marijuana use positively correlated (P=0.04) with completing the study.

To confirm results of the 51 patients who finished the study, researchers reviewed medical records, periodic urine tests, and the state Prescription Drug Monitoring Program (PDMP), and found no aberrations in compliance or prescriptions.

At baseline, the median daily MME of study completers was 288 mg and they had a median of 6 years of opioid use. Pain intensity was 5 out of 10 on a numeric pain rating.

After 4 months, the median daily MME dropped to 150 mg (P=0.002). Pain intensity (P=0.29) and pain interference (P=0.44) did not increase.

This research shows dose and duration may not be as important as we think, Darnall observed.

"Common lore is that patients taking high dose opioids are unlikely to have successful outpatient opioid taper results -- or if they have been taking opioids for years or even decades they will likely have a poor taper response," she said. "To the contrary, we found that starting dose and duration of use did not predict taper response."

It also "helps debunk the idea that patients have to stay on dangerously high doses," said Andrew Kolodny, MD, of Brandeis University in New York and a prominent opponent of opioids for chronic noncancer pain. "It shows that with support and patience, people can come down to safer levels."

"But what's unaddressed is that the majority of these individuals would probably be better off if they could come completely off opioids," he told 木瓜直播. "That's much more difficult to achieve."

Darnall recently received from the Patient-Centered Outcomes Research Institute (PCORI) to expand tapering research to four states in the western U.S., looking at 12-month outcomes.

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