Our new JAMA study on opioid tapering challenges assumptions, holds promise for patients

Chronic pain affects up to one-third of the world population. We recognize that an individual approach to treating pain is needed and that for some patients, prescription opioids are necessary. However, the overemphasis on treating chronic pain with opioids has been associated with substantial morbidity and mortality. With 6.8% of the U.S. population now taking long-term opioids, there is an urgent need to reduce opioids and patient risks and to treat pain better.

In my team’s new JAMA Internal Medicine study, we report our pilot data showing a potential method for effectively tapering patients on high-dose opioids without increasing their pain. This is the first report of community-based voluntary outpatient opioid tapering -- a method that can be scaled and broadly implemented across the U.S. with limited or no additional resources. Our results challenge common assumptions held by patients and the medical community about opioid tapering (that it will increase or cannot be done on an outpatient basis if doses are high), establishes a low-cost solution suitable for further study, and may dismantle several key barriers to reducing opioids effectively for patients who wish to do so. Limitations to note: (1) we studied patients who engaged voluntarily; (2) the study methods focus on increasing patient willingness to taper by helping them feel and be in control of the taper pace, and by providing them the right information; (3) anyone receiving treatment for substance use disorder was excluded; (4) replication is needed.

Read the full research here.

Dr. Darnall is now leading a team to study these patient-centered voluntary opioid tapering methods further. She recently received an $8.8 million PCORI research award to do so.

This multi-site study includes the implementation of these opioid tapering strategies and a randomized controlled trial (RCT) of two evidence-based behavioral chronic pain treatments (compared to patient-centered voluntary taper only) in almost 900 patients taking long-term opioids in 4 Western states. Patients were involved in the design of the study and will be involved at all stages of research.

The impact of this implementation research is underscored by our team having just received a Plenary Research Highlights Award and a feature presentation slot at the American Academy of Pain Medicine annual conference in Vancouver, Canada in April 2018 (post-doctoral fellow Dr. Maisa Ziadni will present our research findings).