Abrupt Cessation of Long-Term Opioid Prescribing Common

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Most Medicare patients stopping long-term opioids experienced ‘falling off a cliff’ drug changes.

Medicare beneficiaries were increasingly likely to have long-term opioid therapy stopped in recent years and medication changes often were abrupt, not tapered, an observational study showed.

Long-term opioid discontinuations among Medicare Part D beneficiaries increased by 49% from 2012 to 2017 and most were rapid, “falling off a cliff” drug changes, reported Michael Barnett, MD, MS, of Harvard T. H. Chan School of Public Health and Brigham and Women’s Hospital in Boston, and co-authors.

The proportion of abrupt opioid discontinuations increased over time, from 70.1% in 2012 to 81.2% in 2017 (P<0.001), they wrote in the Journal of General Internal Medicine.

Patients on long-term opioid therapy “face significant stigma and misunderstanding in the current healthcare system,” Barnett said. “There are many reports of patients being indiscriminately discontinued from their medications, but little data to investigate these concerning reports,” he told MedPage Today.

“The vast majority of long-term opioid users whose therapy was discontinued had an extremely rapid, abrupt taper that was far outside of guideline recommendations,” Barnett added. “It would have been concerning to find that, say, one in four long-term opioid users had abrupt cessation of their therapy but we found that it was most, even among those with very high daily doses of opioids.”

The CDC and FDA have published cautions against abrupt tapering, citing it as dangerous to patient health, noted Beth Darnall, PhD, director of the Stanford University Pain Relief Innovations Lab, who wasn’t involved with the research.

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