Investigators at the Center for Clinical Epidemiology and Population Health and the Center for Precision Medicine Research at Marshfield Clinic Research Institute have begun to study the effectiveness and safety of tapering patients with chronic pain off high-dose opioid prescription drugs.
Tapering is a process where a patient is weaned off opioid relievers, such as hydrocodone or oxycodone, in an effort to lessen the withdrawal symptoms. In the past 20 years across the U.S., there has been more than 200,000 deaths from opioid pain reliever overdoses.
In response to this opioid epidemic, a 2016 Centers for Disease Control and Prevention guideline recommended tapering opioid doses for treatment of patients with long-term pain. However, some doctors are concerned that misapplication of this practice could lead to increased pain, prompting some patients to seek illicit opioids such as heroin or "street bought" fentanyl.
"Medication tapering is one approach health care systems are taking to reduce risks associated with opioid use. However, we don't have a lot of evidence that tells us how fast doses should be decreased or if tapering in some patients leads to unintended consequences such as substance use disorder and heroin use," said Jonathan Badger, research project pharmacist with the Center for Precision Medicine and Research and co-investigator on the study.
This observational study will examine opioid tapering patterns and overdose outcomes. The results will help improve guidelines on opioid management for patients with chronic pain. The study is funded by a grant from the National Institutes of Health to Kaiser Permanente Institute for Health Research in Colorado. The Research Institute will participate as a collaborating site.
"Marshfield Clinic Health System's expertise in rural health provides insight on the impact of the opioid crisis in rural communities compared to its urban effects," said David McClure, Ph.D., senior epidemiologist for the Center for Clinical Epidemiology and Population Health and Marshfield study lead investigator.
For nearly a decade, Marshfield Clinic Health System has been working on reducing opioid addiction through many programs under the leadership of Michael Larson, Ph.D., clinical psychologist and director of controlled medication policy.
"This is one of the first large studies that actually looks at the safety and outcome of tapering," said Dr. Larson. "We'd like to better understand how people with chronic pain should be managed, rather than one-size-fits-all policies."