Discontinuation of Opioid Therapy for Pain May Increase the Risk of Overdose in Patients
Opioid-related overdose has become a major contributor to accidental deaths in the United States and Canada. A new study recently published in the journal PLOS Medicine, led by Mary Clare Kennedy of the University of British Columbia, Kelowna, Canada, indicates that stopping prescribed opioids may increase the risk of overdose.
In an effort to decrease opioid-related illness and death, Canada and the United States have established guidelines to limit opioid prescriptions for chronic pain. However, the impact of discontinuing opioid treatments on overdose risk remains largely unstudied. To investigate the relationship between discontinuing prescribed opioid therapy for pain and overdose risk, a team of researchers conducted a retrospective cohort study of individuals receiving long-term opioid therapy for pain in British Columbia between October 2014 and June 2018. They studied the medical records of 14,037 patients registered with the provincial health insurance client roster in British Columbia who had been on opioid therapy for at least 90 days.
Importance of Tapering Strategies
The researchers found that discontinuing opioid therapy for pain was associated with increased overdose risk among people without opioid use disorder (OUD). Yet the association was stronger in those with OUD, including those not receiving opioid agonist therapy (AHR = 3.18; 95% CI = 1.87 – 5.40, p<0.001) and receiving opioid agonist therapy (AHR = 2.52; 95% CI = 1.68 – 3.78, p<0.001). Finally, tapering opioid therapy was associated with decreased risk of overdose in those with OUD who had not received opioid agonist therapy (AHR = 0.31, 95% CI = 0.14 – 0.67, p=0.003).
The study had several limitations as the outcome measure did not capture overdose events that did not involve a healthcare encounter or result in death. Additionally, the researchers were unable to determine the source of the drugs involved in overdoses and whether they were prescribed or obtained illicitly.
According to the authors, “These findings point to the need to avoid abrupt discontinuation of opioid treatment for pain and to enhance guidance for prescribers in modifying opioid treatment tapering strategies on the basis of opioid use disorder and opioid agonist therapy status.”
Kennedy adds, “Given the increased risk of overdose, sudden discontinuation of opioid treatment for chronic pain should be avoided in almost all instances. Enhanced guidance is needed to support prescribers in implementing safe and effective opioid for pain tapering strategies, with particular consideration of opioid use disorder and prescribed opioid agonist therapy status.”
Reference: “Discontinuation and tapering of prescribed opioids and risk of overdose among people on long-term opioid therapy for pain with and without opioid use disorder in British Columbia, Canada: A retrospective cohort study” by Mary Clare Kennedy, Alexis Crabtree, Seonaid Nolan, Wing Yin Mok, Zishan Cui, Mei Chong, Amanda Slaunwhite and Lianping Ti, 1 December 2022, PLOS Medicine.
DOI: 10.1371/journal.pmed.1004123
This study was funded by a Canadian Institutes of Health Research Project Grant. SN is supported by the Michael Smith Foundation for Health Research and the University of British Columbia’s Steven Diamond Professorship in Addiction Care Innovation. LT is supported by a Michael Smith Foundation for Health Research Scholar Award. The funders had no role in study design, data collection, and analysis, decision to publish, or preparation of the manuscript.
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34 Comments
Never ever heard a cronic intractable pain patient state they got a pleasure trigger from talking pain medicine to manage their excrutiating pain. What a screwed up theory to add antiabuse properties into pain medicine which is made to ease the pain of people who allready feel like s%!t and make them feel sick and like s%!t from taking the medicine that is supposed help them manage their pain so that they can live their life.
The problem is DR’s,the body becomes dependent quickly,,m Dr’s HAD ME upto 180 mg’s per day for 10yrs,could not tske it anymore,and right about that time the fed put it all the new guidelines and the very same Dr’s THAT did all the prescribing are now calling THE same patients drug seekers,God forbid ou asked a question about dosage.Then we were turned away and sent to pain management ONLY to be ridiculed by Neelly appointed NATZIS,I WOULD NOT DEAL WITH IT,SO I QUIT ALL COLD TURKEY,BOY WAS THAT THE MOST DIFFICULT THING I EVER DID,BUT I DID IT,AND GLAD I DID,AFTER STOPPING OPIATES FOR A FEW MONTHS HAD POOR APPETITE,TERRIBLE SLEEP,THEN ALL OF A SUDDEN THINGS JUST KEPT GETTING BETTER AND BETTER,IT TAKES TIME FOR THE DRUG TO GET OUT OF EVERY KNOOK AND CRANNY IN THE BODY,AND I ALSO REALIZED I WAS IN LESS PAIN OFF THE MEDS THAN WHEN ON,I WAS INJURED ON THE JOB AT 44YRS OLD,IM 61 NOW AND HAVE SOMEWHAT OF A LIFE,I DONT SIT WELL TO BEGIN WITH,NEVER COULD,BUT MOVEMENT IS THE KEY,DO SOMETHING,GET OUT,THE MORE YOU DO,THE BETTER YOU WILL FEEL,,,,YES I STILL HAVE PAIN,ESPECIALLY WITH BAD WEATHER,AND WHEN IM HAV8NG A DIFFICULT DAY,I MAKE IT A MOVIE DAY,ROLL UP ON THE COUCH WITH MY ROTTI,AND WE CRITIQUE OLD FILMS,LOL,,,JUST REMEMBER,ONLY YOU CAN MAKE THE CHOICE FOR IT TO WORK WITH STOPPING OPIATES,I THINK THE PEOPLE THAT ARE FORCED TO MAKE CHANGES WITHOUT BEING ON BOARD ARE THE ONES KICKIN THE BUCKET,SO SAD,,,,,YOU CAN DO IT,THATS ALL YOU NEED TO KNOW,GOOD LUCK TO ALL GOING THROUGH THIS
Yes absolutely it’s not good to stop opioid meds for chronic pain patients that are still in pain due to back issues and deformed bodies
For the people that came off medication cold turkey and are supposably doing better and having less pain if that’s true you didn’t have much pain to start with so why be on pain medication. For those of us with real documented pain x-rays mri’s surgery and then new guidelines change and we get taken off medication that we need to keep us out of just enough pain to be able to work pay bill clean the house go grocery shopping people like us need our medication some in very low doses some very high doses what alot of people don’t know is pain medication acts differently in every person one person may get great pain relief from 4 Tylenol 3 another might need 80 MG of morphine 6 times a day and that barely touches their pain the person that needs the higher dose has a type of Metabolite that literally disposes over half of the opiods they take so there body is only using maybe just 5mg of the 80mg morphine every person’s body is different so stopping medication and exercising is not going to help everyone but it would be nice if it did. They lowered my medication so low I couldn’t get ready for work without excruciating pain. So I left my pain management clinic and I went into what is called a methadone clinic. The great thing about those is they don’t have a cut off level for milligrams. They test your blood to see how much of the medication your body is actually using. And they actually use science and labs and talk to you The doctors slowly work you up. Dose that helps, and it works for you. They use lots of techniques and do it right I. Am in less pain now than I have been in the last several years since the dumb mother fucker that dont know shit about pain have have probale never had more pain than a headache put new recommendations in place. I don’t know what I would do if I didn’t go there. So not everybody can just quit taking thier medication and walk and have less pain I’m one of those people that can barley move without the correct dose of medicationand there is alot of people that are the same so do some fucking research and remember that before you write this s***, you write. And the worst thing about all of this they say they did that new law c*** because we had an opioid epidemic at the time. No, we did not haven’t a opioid epidemic then, but because of what they did. We sure as hell have a horrible one now. And it’s only gettingso much worse,good job, America f***** it all up again. I hope there proud of them selfsame now.
The problem is DR’s,the body becomes dependent quickly,,m Dr’s HAD ME upto 180 mg’s per day for 10yrs,could not take it anymore,and right about that time the fed put it all the new guidelines and the very same Dr’s THAT did all the prescribing are now calling THE same patients drug seekers,God forbid you asked a question about dosage.Then we were turned away and sent to pain management ONLY to be ridiculed by NATZIS,I WOULD NOT DEAL WITH IT,SO I QUIT ALL COLD TURKEY,BOY WAS THAT THE MOST DIFFICULT THING I EVER DID,BUT I DID IT,AND GLAD I DID,AFTER STOPPING OPIATES FOR A FEW MONTHS HAD POOR APPETITE,TERRIBLE SLEEP,THEN ALL OF A SUDDEN THINGS JUST KEPT GETTING BETTER AND BETTER,IT TAKES TIME FOR THE DRUG TO GET OUT OF EVERY KNOOK AND CRANNY IN THE BODY,AND I ALSO REALIZED I WAS IN LESS PAIN OFF THE MEDS THAN WHEN ON,I WAS INJURED ON THE JOB AT 44YRS OLD,IM 61 NOW AND HAVE SOMEWHAT OF A LIFE,I DONT SIT WELL TO BEGIN WITH,NEVER COULD,BUT MOVEMENT IS THE KEY,DO SOMETHING,GET OUT,THE MORE YOU DO,THE BETTER YOU WILL FEEL,,,,YES I STILL HAVE PAIN,ESPECIALLY WITH BAD WEATHER,AND WHEN IM HAV8NG A DIFFICULT DAY,I MAKE IT A MOVIE DAY,ROLL UP ON THE COUCH WITH MY ROTTI,AND WE CRITIQUE OLD FILMS,LOL,,,JUST REMEMBER,ONLY YOU CAN MAKE THE CHOICE FOR IT TO WORK WITH STOPPING OPIATES,I THINK THE PEOPLE THAT ARE FORCED TO MAKE CHANGES WITHOUT BEING ON BOARD ARE THE ONES KICKIN THE BUCKET,SO SAD,,,,,YOU CAN DO IT,THATS ALL YOU NEED TO KNOW,GOOD LUCK TO ALL GOING THROUGH THIS
Not everyone who takes an opioid is going to be addicted. Be aware of what bad press does to a drug that for over a thousand years has worked on pain. It’s what other crap they add makes it bad.
I’ve been on opiates for over 20 years for severe, intractable chronic pain. I have NOT ever abused my meds, taken more medication than prescribed, nor have I diverted my meds or attempted to sell them.
I have also never gotten a buzz or felt high. I am not a drug addict. I do not crave opiates, in fact I hate having restrictions due to the rules and regulations surrounding them.
My medication is for such severe pain, that if I was ever forced to stop them, I would literally curl up and die. It is excruciating. I’m not using my pain to manipulate my doctors or others. Because of my medication I was able to work for another 20 years as a nurse. They saved my life and allowed me to have some quality of life in which I was able to raise my son and provide for him as a mother should.
Hi – I was a PT hurt on the job 10 years ago. I was given pain meds then, but 3 years ago they started cutting them down & now I’m at such a low dose it does barely anything for the pain. I got my medical marijuana license but can’t afford that stuff. I understand that some people should have NEVER been given narcotic pain medicine. But for others it made life LIVABLE. & now it’s not. There’s gotta be some middle ground. Too many extremes.
Well said, Thank you. The anti-opioid movement was started by doctors with stock in Suboxone. Opiates are the best working and least damaging drug for long term pain management and doctors know this. The DEA should not be regulating medicine and The DOJ needs to tell them so before their anti-opioid hysteria kills even more people. Patients are in need of pain management, not policing.
I agree!
I’ll just say this! I’m in so much pain 24/7 and will never get any help from a doctor I wish they would all die and burn in hell.
What is unstated in this article is the MENTAL HEALTH changes that suddenly varying a chronic pain sufferers’ dosage of opioids can cause. Chronic pain already goes hand in hand with lack of regular sleep, and a careful balance of opioids and the other drugs prescribed for the side effects of opioids means that any sudden changes to this balance can result in hallucinations, paranoia, silly behavior, etc. In some cases, multiple involuntary committals to the psych ward are required before the “correct” mix is found.
Pain, especially chronic pain, is perhaps the least understood medical condition there is. And all doctors can do for it is guess at what MIGHT work! Oops you went crazy again, let’s try THIS drug combo instead. Oops again, let’s try THAT one.
I have taken Lortabs for 32 years. I started after getting my tonsils out and taking them 2 weeks.After that was endometriosis and bad pain and then kidney stones and back pain from nursing injuries. I was finally up to 4 , 10s a day. Much needed for fibromyalgia and arthritis as I am now in my 60’s. Before I could take a name brand pill and 2 a day would help. Then they started giving everyone generic and you need 4 to kill the pain that used to work with 2. The pharmaceutical companies make them weak with terrible additives that some give me headaches. I know many people that have the same problems and it is not only me . So now due to all the opioid hullabaloo, the responsible patients that could take a brand name twice a day and don’t want 4 a day of the garbage ones made in foreign countries and only have to have certain percentage of the pain relieving chemical to pass their regulations. I have wanted to get off this stuff for 32 years but my dr can’t come up with a suitable substitute.Why? What’s bad is I feel like I’m treated like only a drug seeker bc I want a certain generic ( that don’t give me headaches) I even asked my Dr. If j could try smoking marijuana in order to relieve the pain and get off these pills. I don’t care what I take as long as the pain can be stopped. But no , although it’s legal in my state , it’s not federally recognized. OR THE PAIN MED COMPANIES ARE GONNA LOSE MONEY. MONEY, MONEY, MONEY, That’s what matters. Not lives. My friend went to a rehab place and they sent her to a Dr. In Tennessee that was an EENT and gladly wrote out the suboxone scripts for $500 and the med was $100-$200. So who can come up with $700 a month? Especially when they were promised that they could be off of all meds in 18-24 months and it has been over 2 years. That’s a shame if the money that this physician has gotten just from my friend not counting all the other patients he has done this too. It’s a shame and those are the ones that needs to burn in hell. Instead of helping they set you up to pad their wallets. Meanwhile mine has been cut to 3 a day and they are cheap and not relieving the pain . That’s why people want to commit suicide , bc the pain won’t go away . Or the doctors are fleecing those poor people that want and need help. So what’s the answer. ?
CORRECTION: my friend has been seeing this ENT dr for 12 years now. So that is over $10,000 that this Dr has made off of 1 patient so he is very rich if he has many patients and I Know he does from talking to nurses that work in the hospital with him.
From your friend alone he has earned off him over $100,800. But if you only count the money for the doctor it is $72000 over a 12-year period. That’s really a shame that your friend has to endure the cost of just trying to function throughout the day. And I know from myself beyond oxycodone for 10 years now because of my first aggravation of MS.
Its not that tricky..a person in lots of pain will get something for it..now if the doctor won’t do it..your next choice is from the street and that’s who knows what is the right dose.hense overdose.
I haven’t drank in many many years I honestly dont like it..but the fact I cant get pms medication I’m not seeking anything..I am seeking treatment for my pain.thats seems to be like asking the doctor to commit a crime..plus my s%!tty insurance wont fill anything I manage to get prescribed.so far I’ve ended up in the hospital..overdosed on street drugs.im at the point where I yell at the paramedics for narcaning me.is this what I diserve..granted I’ve never had pain meds prescribed I have no history..yet I’m a drug seeker.all I can say is go f*@k yourselves.im not a child I think I can manage my pain without consequences I can deal with.
Once a person stops doing drug’s, the body automatically starts to clean itself through detoxification. However we knew that the disease of addiction still grows with the person who did the drug’s. A very high level of tolerance is built daily, so the longer the person is clean, the higher the tolerance. We knew this in the 80’s when everyone was coming off cocaine, heroine and Alcohol. The problem is when the person relapses they continue where they left off to try to get that euphoria, the very first drug. At anytime during this period the person’s tolerance drops out and a massive overdose takes place. Usually the person does not survive, and like millions they die. I have years and years of experience, and there is no way I would put my life, my wife’s life, my children’s lives in jeopardy over some stupid drug or drugs. People choose to live or die, you can’t blame every doctor, you can’t blame the manufacturer, or the Pharmacys. People have a choice to do drug’s or not to, take medicine correctly and stop after a few days, or just deal with pain. I deal with pain daily and it is ruthless. I choose to not die just for today
Your pain is clearly not even in the same nation with real chronic pain sufferers! When your pain is so bad that you can’t take a bath or fix a TV dinner and when you start thinking about ways to off yourself just to get away from it…… then you can talk…..
Mark, you are an ignoramus. It all comes down to “just say no”? I wish that were true. Maybe you could try to educate yourself a little more before passing judgement or telling people to make better choices. Especially saying it to the ones that are so uncomfortable that just sitting in a chair is excruciating because of chronic pain.
I strongly suggest that you’re narrow-minded comment about taking drugs in general is a choice. Yes is a choice to put something in my mouth and swallow. But if it takes away the pain to be able to get out of bed get into my wheelchair and interact with my family I will gladly take my opiates along with the other 17 minutes I take due to my MS diagnosis. I went from being actively working 60 hours a week and running 5 miles a day to waking up one day and not being able to move my whole right side. Your comment might be more suitable for people that have a minor surgery and I’ll take narcotics for a couple weeks until they’re healed from whatever they had done. But when it comes to someone that is taking narcotics because of a neurological disorder, cancer which there are a variety of, or if they have some form of body part that didn’t develop the way that it was supposed to and is either deformed or not there. Are the ones that everyone is talking about not the people that are looking for a high because they want to be high. I don’t get high from my narcotics that I’ve been taking for over 10 years. I get no euphoric feeling in fact I’m still in pain throughout the day but I take just enough so I can interact with my family. So please again keep your narrow-minded thoughts to yourself and actually read what the article was about. And just to let you know it was about chronic pain as in people with the need to be on these narcotics not because they want to get high but because they just want to make it through the day!
I strongly suggest that you’re narrow-minded comment about taking drugs in general is a choice. Yes is a choice to put something in my mouth and swallow. But if it takes away the pain to be able to get out of bed get into my wheelchair and interact with my family I will gladly take my opiates along with the other 17 minutes I take due to my MS diagnosis. I went from being actively working 60 hours a week and running 5 miles a day to waking up one day and not being able to move my whole right side. Your comment might be more suitable for people that have a minor surgery and I’ll take narcotics for a couple weeks until they’re healed from whatever they had done. But when it comes to someone that is taking narcotics because of a neurological disorder, cancer which there are a variety of, or if they have some form of body part that didn’t develop the way that it was supposed to and is either deformed or not there. Are the ones that everyone is talking about not the people that are looking for a high because they want to be high. I don’t get high from my narcotics that I’ve been taking for over 10 years. I get no euphoric feeling in fact I’m still in pain throughout the day but I take just enough so I can interact with my family. So please again keep your narrow-minded thoughts to yourself and actually read what the article was about. And just to let you know it was about chronic pain as in people with the need to be on these narcotics not because they want to get high but because they just want to make it through the day!
In my reply was towards Mark!
I’m not sure where your years of experience came from but you just accused every patient on pain med of being a drug addict. That right there proves you have very little knowledge of the subject. You are also very confused adout the reason people with chronic pain take pain meds it most definitely is not for some euphoric feeling. I personally have been on pain medication for almost fifteen years and I have not had a single euphoric feeling for the majority of that time. What I have had is a reduction in the severity of the pain I live with and will continue to experience for the rest of my life. Pain aslo is not a one size fits all and to compare the pain that you experience to anyone else without any knowledge of thier condition is an insult at best and pure ignorance at the worst. It is because of people like you who show no empathy for your fellow man that are at the root of the problem. Yes there people who game the system but don’t pass judgment on the vast number of people who are simply trying to live the best life possible under circumstances beyond their control and which you obviously haven’t the fogest understanding of.
I have to agree with you George Whitten. People speak out, like they know it al. I had a bad accident at work and injured myself. I had several surgeries on my shoulder and neck and no rellief.I tried nerve blocks, cortisone injections,a electric stimulator,physical therapy to no avail. I am on medication for depression and pain because it robs you of your normal life. If it weren’t for the relief I get…I would never get out of bed!!! So I take them as prescribed and have no problems.
It’s not the doctors … we need to know who made the 2016 opioid guidelines .. someone did this ! And those people need to be identified .. hard to fight an invisible enemy hiding behind a cloak ! Thank God for researchers fighting the battle !! As a former pharmacist I witnessed real people dying first hand from this man made opioid crisis 😢
my life was going along, and a person turned into.her driveway rite accords the road I was coming.down she turned in front of me no Blinker just turned I stood both feet on the Brake light
Pedal the impact went down my Spine pushing jamming BONE into BONE I couldn’t walk after that she had no COVERAGE SO SHE TOOK MY LIFE MY JOB ALL I DO IS SUFFER 24/7 I WAS ON MEDICATION BUT I HAD TO COME BACK TO MY HOME STATE NEWBEDFORD, MA, WHERE THEY JUST LET YOU SUFFER AND SUFFER???????
Maybe you would be better off moving to another place, a place with more relaxed rules as far as Narcotics is concerned.
Is there a place with more relaxed rules as far as narcotics are concerned? Where does one begin to research such places? Thank you
There have been a lot of these “opioids aren’t all bad” press releases lately. The medical industry writes it’s own laws, our “representative” are middle men. The reason hospitals are under prescribing opioids for pain is to create a public outcry. When there is enough psy ops/ public outcry (for pain relief) our feckless political class will seek to remove all laws inhibiting prescriptions for opioids. They are deliberately under prescribing opioids in order to remove legislation enacted to prevent other prescription.
I moved to another place and was taken off my pain meds. abruptly!!!!!! I have suffered for the entire 3 years I have lived here! I have Ankylosing Spondylitis and Costochondritis, which is also very painful 😣! I am 67 and just left to live in very severe pain!
As a recovering addict 9yrs clean,my addition started with pain and the use of opiods.But I personally know alot of the children that died from an overdose were not ever treated for chronic pain they just got there hands on some opiots experimenting and liked the feeling.So I’m not so sure about this study.
Kate I commend you on your sobriety! You are probably in the category that are not a person with chronic pain. Chronic pain is a situation a person is put in with no control of them themselves. Chronic pain is more in my opinion for those who have diseases such as MS, cancer, Parkinson’s, ALS and etc. Those people are in pain and will be in pain for the rest of their lives. The narcotics in which they take and I am in that category are not for getting a euphoric feeling. It is for getting through the day and then the day after that and the day after that until the day they are no longer here. It is to help with quality of life and shouldn’t be associated with someone who is a addict and addict is a person who doesn’t need said medication like narcotics. And as far as the unfortunate children that you have known or witnessed to die because of getting a hold of narcotics that are around the house. The people that are not putting these certain meds that can cause a children to die from taking someone narcotics in the house isn’t properly putting away by myself have a safe and I keep those type of meds in the safe. That prevents those unfortunate situations from happening with children. So technically it is the fault of the person who didn’t put those medications away and out of the hands of children that can get a hold of narcotics. And if you have an older family member that is living the house that regularly takes narcotics if they cannot put away those narcotics themselves they probably have a caregiver that can. And if they don’t have a caregiver then any children that visit or is around a family member in that situation their parents should be thinking about that before they allow their children to go over or be around those family members that need those narcotics. Meaning the parents should be making sure that a situation like that wouldn’t happen because they have thought in advance and have either put the medications away or those children shouldn’t be in the room that the narcotics are put and also should have a lock on the door if they do not have a safe or a lock box in which two keep narcotics. Remember there’s always two sides and parents need to be cautious by putting the children in a situation where that could happen.
Is there a place with more relaxed rules as far as narcotics are concerned? Where does one begin to research such places? Thank you