Yet another study indicates that patients are being tapered off prescription painkillers at “rapid” rates that surpass federal guidelines.
Among more than 100,000 patients enrolled in both commercial insurance and Medicare Advantage programs, researchers found that the annual percentage undergoing tapering doubled between 2008 and 2017.
In response to the opioid crisis, the Department of Health and Human Services (HHS) released a tapering guideline in 2016 that sent a chilling effect throughout the chronic pain community, experts say. It was recently tempered, but not before physicians and hospital networks began removing pain patients from their medication or sending them away entirely.
HHS suggested tapering patients at gradual doses of about 10 percent a week or possibly less, but some clinicians and hospitals may have interpreted the guideline as a “hard stop,” said the study, which was published November 15 in JAMA (formerly The Journal of the American Medical Association). In 2017, more than a fifth of patients experienced a 15 percent or greater reduction in average daily doses, according to the findings. That’s up from just 10.5 percent of patients in 2008.
Nearly one in five people is tapered by more than 40 percent each month, the researchers found. For people physically dependent on the drugs, this kind of approach can cause crippling withdrawal symptoms, psychological distress and suicide, not to mention uncontrolled pain, according to a recent warning by the Food and Drug Administration (FDA).
Groups that are particularly at risk for getting kicked off their medication in this manner include younger people, women, minorities, people on higher doses of opioids, people who recently overdosed and people on commercial insurance, the study found.
“This study confirms that many chronic pain patients are receiving substandard care,” said Dan Laird, a pain physician and medical malpractice attorney, in a statement. “The opioid crisis is largely driven by illegal fentanyl and heroin, yet chronic pain patients continue to be victimized,” he added.
In another recent survey, which was conducted by Quest Diagnostics and the Center on Addiction, more than four out of five doctors said they were reluctant to take on patients using prescribed opioids. They also said the opioid crisis made it more difficult to treat patients in pain.
“The downstream effects of opioid tapering on pain, withdrawal, mental health, and overdose risk warrant careful evaluation,” concluded the authors of the JAMA study.
Because that project was limited by its reliance on commercial insurance and Medicare Advantage programs, the results may not be generalizable to uninsured people or those enrolled in Medicaid. The data were also derived from administrative claims, which risks measurement error.